Organizational and Market Influences on Physician Performance on Patient Experience Measures

Abstract

Objective. To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. Data Sources. This study employs Clinician and Group CAHPS survey data (n 5 105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. Study Design. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Principal Findings. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p 5 .007) and care coordination ( p 5 .03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p 5 .04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p 5 .04) and care coordination ( po.001) measures. Conclusions. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.

Patients' Perspectives of Care and Surgical Outcomes in Michigan

“…Beyond the surgical literature, evidence from a large statewide demonstration suggests that patients' perspectives of care can incentivize providers to improve quality in the primary care setting. 12, 13 It is unclear whether this information can service as a stimulus for quality improvement in the delivery of surgical care.…”

More than a score: a qualitative study of ancillary benefits of performance measurement

“…Asch et al 18 found that, following the introduction of a PM system, facilities improved not only on PM scores but also on related clinical measures that were not tracked by the PM system. Other studies have found inconsistent relationships between PM and the patient-centeredness of care 19 20. However, none of these studies attempted to identify a comprehensive set of ancillary benefits or to integrate these benefits into a conceptual framework of the effects of PM.…”

A randomized experiment of issue framing and voter support of tax increases for health insurance expansion

“…Compared to Democrats, Republicans had the lowest odds of supporting taxes for citizens (OR = 0.08, p < 0.001) and children (OR = 0.09, p < 0.001), followed by voters with no party affiliation and independents. In multivariable models, only male gender (OR = 1.49, p < 0.05) and younger age (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) were related to more support for taxes to ensure coverage for military veterans. Using categorical variables for the support questions, i.e., maintaining the 5-point response scale, and ordinal logistic regression to assess the relationship between voter characteristics and support did not alter most of the study conclusions.…”

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