Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models

Vu, Thyna; Anderson, Kelly K.; Devlin, Rose Anne; Somé, Nibene Habib; Sarma, Sisira

doi:10.1016/j.socscimed.2020.113465

Cited by 6 publications

(4 citation statements)

References 40 publications

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“…Establishing temporary pathways for shared care, communication, and referrals between walk-in and primary care settings could facilitate seamless care transitions and coordinated follow-up, even in the absence of primary care attachment. This could involve nesting walk-in clinics within enrolling primary care practices, allowing for shared accountability, alignment on funding, and formal affiliations based on geographic and population boundaries [ 60 , 61 ]. This approach has been effective in the United States with psychiatric services.…”

Section: Discussionmentioning

confidence: 99%

“…By partnering with psychiatric walk-in clinics, same-day access for psychiatric care is provided to patients who frequently miss appointments or prefer ambulatory-style care delivery, while enrolling psychiatrists benefit by receiving referrals [61]. Primary care funding structures could also be extended to walk-in physicians to provide them with explicit preventative care incentives or bonuses for enrolling unattached patients [40][41][42][60][61][62]. However, it is important to underscore that these reforms would best serve as interim solutions while striving towards the longterm objective of achieving relationship-based primary care for all [1,63,64].…”

Section: Plos Onementioning

confidence: 99%

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A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada

Terpou,

Lapointe-Shaw,

Wang

et al. 2024

PLoS ONE

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Background High-quality primary care is associated with better health outcomes and more efficient and equitable health system performance. However, the rate of primary care attachment is falling, and timely access to primary care is worsening, driving many patients to use walk-in clinics for their comprehensive primary care needs. This study sought to explore the experiences and perceived roles and responsibilities of walk-in physicians in this current climate. Methods: Qualitative interviews were conducted with nineteen physicians currently providing walk-in care in Ontario, Canada between May and December 2022. Results Limited capacity for continuity and comprehensiveness of care were identified as major sources of professional tension for walk-in physicians. Divergent perspectives on their roles were anchored in how physicians viewed their professional identity. Some saw providing continuous and comprehensive care as an infringement on their professional role; others saw their professional role as more flexible and responsive to population needs. Regardless of their professional identity, participants reported feeling ill-equipped to manage the swell of unattached patients, citing a lack of time, resources, connectivity to the system, and remuneration flexibility. Conclusions: As practice demands of walk-in clinics change, an evolution in the professional roles and responsibilities of walk-in physicians follows. However, the resources, structure, and incentives of walk-in care have not evolved to reflect this, leaving physicians to set their own professional boundaries with patients. This results in increasing variations in care and confusion across the primary care sector around who is responsible for what, when, and how.

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Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada

Terpou,

Lapointe-Shaw,

Wang

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…It is well documented that fee for service incentivizes treatment over prevention and there is a need to move toward value-based care. [10][11][12][13] Kathleen Watt's experience is an extreme example, but there are many instances where dentists' attention to oral health has broad and far-reaching impacts. Recent investigations also show that unemployed individuals were more likely to report that they were better able to look for a job if they had dental access.…”

Section: Leading the Way In Oral Cancer Screeningmentioning

confidence: 99%

“…Additionally, and perhaps more complicated, is the need for reimbursement models to catch up to the advancement of dental practice. It is well documented that fee for service incentivizes treatment over prevention and there is a need to move toward value‐based care 10–13 …”

mentioning

confidence: 99%

Leading the way in oral cancer screening

Reddy,

Nalliah

2024

Journal of Dental Education

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Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis

Somé,

Devlin,

Mehta

et al. 2024

Health Economics

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Improving access to primary care physicians' services may help reduce hospitalizations due to Ambulatory Care Sensitive Conditions (ACSCs). Ontario, Canada's most populous province, introduced blended payment models for primary care physicians in the early‐ to mid‐2000s to increase access to primary care, preventive care, and better chronic disease management. We study the impact of payment models on avoidable hospitalizations due to two incentivized ACSCs (diabetes and congestive heart failure) and two non‐incentivized ACSCs (angina and asthma). The data for our study came from health administrative data on practicing primary care physicians in Ontario between 2006 and 2015. We employ a two‐stage estimation strategy on a balanced panel of 3710 primary care physicians (1158 blended‐fee‐for‐service (FFS), 1388 blended‐capitation models, and 1164 interprofessional team‐based practices). First, we account for the differences in physician practices using a generalized propensity score based on a multinomial logit regression model, corresponding to three primary care payment models. Second, we use fractional regression models to estimate the average treatment effects on the treated outcome (i.e., avoidable hospitalizations). The capitation‐based model sometimes increases avoidable hospitalizations due to angina (by 7 per 100,000 patients) and congestive heart failure (40 per 100,000) relative to the blended‐FFS‐based model. Switching capitation physicians into interprofessional teams mitigates this effect, reducing avoidable hospitalizations from congestive heart failure by 30 per 100,000 patients and suggesting better access to primary care and chronic disease management in team‐based practices.

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Physician remuneration schemes, psychiatric hospitalizations and follow-up care: Evidence from blended fee-for-service and capitation models

Cited by 6 publications

References 40 publications

A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada

A shifting terrain: Understanding the perspectives of walk-in physicians on their roles amid worsening primary care access in Ontario, Canada

Leading the way in oral cancer screening

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis

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