Professional integration and the type chosen for many health care organizations will determine their success as they begin implementing the Patient Protection Act and affordable care (PPACA). Cuellara and Gertlerb (2006) list the five most commonly used arrangements: independent physician associations (IPA), open physician and hospital organizations (OPHO), closed physician and hospital organizations (CPHO), management service organizations (MSOs) and fully integrated organizations. Organizations (FIO). Each of these five types of professional integration has been shown to be effective, but there have been many failures, which ultimately led to a decline in access and quality of health care in these communities. The hospital partnerships that I selected are the IPA and the FIO. IPAs and FIOs are at the opposite end of the spectrum of professional integration. The main points for each type are described below. Independent Physician Associations (IPAs) IPAs are a group of physicians who own a practice and are not employed by another healthcare organization such as a hospital or health maintenance organization (HMO). IPA physicians form a legal corporation, partnership, or foundation and contract as a group to provide their services. Some APNs contract with HMOs while also seeing non-HMO patients. The IPA shares the economic risk but not the overhead costs. Fully Integrated Organizations (FIOs) Under the FIO structure, the healthcare company purchases a medical practice to include the physician's services. Physicians become employees and, in some organizations, share governance with health care management. However, FIO...... middle of document ......g/publications/policy_primers/pdfs/pp-2005-12.pdf.Cuellara, AE & Gertlerb, PJ (2006). Strategic integration of hospitals and doctors. Journal of Health Economics, 25(1), 1-28. Retrieved February 21, 2011 from http://members.cox.net/mshachar/Cuellar_2006_via_TUI.htm. Fraschetti, RL and Sugarman, M. (2009). Successful Hospital-Physician Integration: Shared governance and decision-making help an integrated California health care network thrive. Pivot Health website. Accessed February 21, 2011, from http://www.pivothealth.com/userfiles/pdf/090701%20Bob%20Fraschetti%20Michael%20Sugarman%20Successful%20Hosiptal-Physician%20Integration%20Trustee.pdf.St. Jude Heritage Medical Group Homepage. (2011). St. Jude Heritage Medical Group receives top honors. St. Jude Heritage Medical Group website. Retrieved February 23, 2011 from http://www.sjhmg.com/.