Proportion Of Physicians In Large Group Practices Continued To Grow In 2009-11 (original) (raw)
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Benefits of and Barriers to Large Medical Group Practice in the United States
Archives of Internal Medicine, 2003
Background: For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. The growth of managed care and the movement to improve quality provide additional reasons for physicians to practice in groups, especially large groups. However, information is lacking on recent trends in group size and the benefits of and barriers to group practice. Objectives: To identify benefits of and barriers to large medical group practice, and to describe recent trends in group size. Design, Setting, and Participants: Information on benefits and barriers was obtained from 195 interviews conducted during round 3 (2000-2001) of the Community Tracking Study with leaders of the largest groups, hospitals, and health insurance plans in 12 randomly selected metropolitan areas. Information on recent trends in group size was obtained from more than 6000 physicians in private practice in 48 randomly selected metropolitan areas via Community Tracking Study telephone
Medical Care Research and Review, 2018
Physician practices have been growing in size, and becoming more commonly owned by hospitals, over time. We use survey data on physician practices surveyed at two points in time, linked to Medicare claims data, to investigate whether changes in practice size or ownership are associated with changes in the use of care management, health information technology (HIT), or quality improvement processes. We find that practice growth and becoming hospital-owned are associated with adoption of more quality improvement processes, but not with care management or HIT. We then investigate whether growth or becoming hospital-owned are associated with changes in Medicare spending, 30-day readmission rates, or ambulatory care sensitive admission rates. We find little evidence for associations with practice size and ownership, but the use of care management practices is associated with lower rates of ambulatory care sensitive admissions.
Medical Group Characteristics and the Cost and Quality of Care for Medicare Beneficiaries
Health Services Research, 2018
Objective. To estimate the relationship between outcomes of care and medical practices' structure and use of organized care improvement processes. Data Sources/Study Setting. We linked Medicare claims data to our national survey of physician practices (2012-2013). Fifty percent response rate; 1,040 responding practices; 31,888 physicians; 868,213 attributed Medicare beneficiaries. Study Design. Cross-sectional observational analysis of the relationship between practice characteristics and total spending, readmissions, and ambulatory care-sensitive admissions (ACSAs), for all beneficiaries and five categories of beneficiary defined by predicted need for care. Principal Findings. Practices with 100+ physicians and 50-99 physicians had, respectively, annual spending per high-need beneficiary that was 1,870(12.5percent)and1,870 (12.5 percent) and 1,870(12.5percent)and1,824 higher than practices with 1-2 physicians, and readmission rates 1.64 and 1.71 higher. ACSA rates did not vary significantly by practice size. Outcomes did not vary significantly by ownership or by practices' use of organized processes to improve care. Conclusions. Large practices had higher spending and readmission rates than the smallest practices, especially for high-need beneficiaries. There were no significant performance differences between physician-owned and hospital-owned practices. Policy makers should consider the effects of specific policies on provider organization, pending further research to learn which types of practice provide better care.
The Relationships of Physician Practice Characteristics to Quality of Care and Costs
Health services research, 2014
Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care. Practice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims-computable measures of screening and monitoring, avoidable utilization, risk-adjusted per-beneficiary per-year (PBPY) costs, and the practice's net revenue. Several characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved sc...
Medicare Physician Group Practices: Innovations in Quality and Efficiency
The Centers for Medicare and Medicaid Services initiated the Physician Group Practice (PGP) Demonstration to provide participating practices the opportunity to earn performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service (FFS) beneficiaries. This report discusses experiences of the participating practices, as well the implications for the Medicare program and the health care system overall. To date, the PGP demonstration experience has shown that it is possible for large, multi-specialty group practices to respond to a hybrid set of quality improvement and cost-containment incentives layered on top of an FFS payment system. PGPs have used the demonstration to expand data systems, care management programs, coordination-of-care efforts, and other interventions that are not directly reimbursed. At the same time, the PGP demonstration system retains many of the positive features of FFS reimbursement, such as the patient'...
2001
The U.S. office based physician market has experienced substantial changes in recent years. A growing number of office based physicians are practicing in large group practices, and vertical integration between hospitals and physician group practices through ownership and contractual relationships has accelerated.1 Understanding the organizational characteristics of office based physicians and how those characteristics are associated with use and costs of care are critical to informing policies designed to promote high-quality and efficient health care delivery.
Differences in practice income between solo and group practice physicians
Health Policy, 2006
An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal-Wallis test results revealed the existence of significant relationships between practice incomes and practice types (p < 0.001) and the number of physicians within a clinic (p < 0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group practices (p < 0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices.
Health Services Research, 2017
Objective. To examine the relationship of physician versus hospital ownership of small-and medium-sized practices with spending and utilization of care. Data Source/Study Setting/Data Collection. Survey data for 1,045 primary carebased practices of 1-19 physicians linked to Medicare claims data for 2008 for 282,372 beneficiaries attributed to the 3,010 physicians in these practices. Study Design. We used generalized linear models to estimate the associations between practice characteristics and outcomes (emergency department visits, index admissions, readmissions, and spending). Principal Findings. Beneficiaries linked to hospital-owned practices had 7.3 percent more emergency department visits and 6.4 percent higher total spending compared to beneficiaries linked to physician-owned practices. Conclusions. Physician practices are increasingly being purchased by hospitals. This may result in higher total spending on care. Key Words. Ambulatory/outpatient care, health care organizations and systems, ownership/governance Health care reform appears to be accelerating two decades-old trends: physician practices are increasingly owned by hospitals, and physicians in small practices are moving into medium-sized and large practices (Burns, Goldsmith, and Sen 2013; Casalino 2014). Between 2013 and 2015, the percentage of physicians in practices with 1-24 physicians (i.e., small-and medium-sized practices) decreased from approximately 48 percent to approximately 42 percent; the percentages were similar for primary care physicians (Muhlestein and Smith 2016). Estimates of the percentage of physicians employed by hospitals vary (Burns, Goldsmith, and Sen 2013; Kane 2015); a recent study