Relationship of Primary Care Physicians' Patient Caseload With Measurement of Quality and Cost Performance

Nyweide, David J.; Weeks, William B.; Gottlieb, Daniel J.; Casalino, Lawrence P.; Fisher, Elliott S.

doi:10.1001/jama.2009.1810

Cited by 52 publications

(57 citation statements)

References 19 publications

(13 reference statements)

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“…IMS data are widely accepted and have been used in dozens of studies published in peer-reviewed journals. 20,21 Practices were eligible for the survey if they had 1-19 physicians of whom at least 60 percent were some combination of adult primary care providers (family physicians, general internists, and general practitioners), cardiologists, endocrinologists, and pulmonologists. We included only practices with these specialties because the survey focused on care management processes for preventive care and for four major chronic illnesses: asthma, congestive heart failure, diabetes, and depression.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…20 In this study we asked participants whether the major health plans that insured their patients provided their practice with any of the following care management tools and resources for chronic illness: a list of patients, performance data, patient reminders, patient educators, and care managers. A single "health plan activities index" was created for each practice (one point for each process used by health plans; range: 0-5).…”

Section: Measurement Of Medical Home Processesmentioning

confidence: 99%

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Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes

Rittenhouse

Casalino

Shortell³

et al. 2011

Health Affairs

190

218

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The patient-centered medical home has become a prominent model for reforming the way health care is delivered to patients. The model offers a robust system of primary care combined with practice innovations and new payment methods. But scant information exists about the extent to which typical US physician practices have implemented this model and its processes of care, or about the factors associated with implementation. In this article we provide the first national data on the use of medical home processes such as chronic disease registries, nurse care managers, and systems to incorporate patient feedback, among 1,325 small and medium-size physician practices. We found that on average, practices used just one-fifth of the patientcentered medical home processes measured as part of this study. We also identify internal capabilities and external incentives associated with the greater use of medical home processes.T he patient-centered medical home model of health care delivery system reform was featured prominently in the Affordable Care Act of 2010. The model was developed by the primary care specialty societies in 2007. It has been endorsed by a broad coalition of purchasers, payers, providers, consumers, and other health care stakeholders. It emphasizes a robust system of primary care combined with practice innovations and new payment models.

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Section: Study Data and Methodsmentioning

confidence: 99%

Section: Measurement Of Medical Home Processesmentioning

confidence: 99%

Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes

Rittenhouse

Casalino

Shortell³

et al. 2011

Health Affairs

190

218

View full text Add to dashboard Cite

show abstract

“…16 These data are widely accepted and have been used in many studies published in peer-reviewed journals. [16][17][18] Using this database and the eligibility criteria described above, we drew a random sample of practices stratified by practice size, specialty mix, and location. Additionally, all practices that responded to earlier surveys involving the Second National Study of Physician Organizations 19,20 and the NSSMPP 21,22 were recontacted to respond to the NSPO3 survey.…”

Section: Data Sources and Study Samplementioning

confidence: 99%

Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study

et al. 2017

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PURPOSE Implementation and meaningful use of health information technology (HIT) has been shown to facilitate delivery system transformation, yet implementation is far from universal. This study examined correlates of greater HIT implementation over time among a national cohort of small primary care practices in the United States. METHODSWe used data from a 40-minute telephone panel survey of 566 small primary care practices having 8 or fewer physicians to investigate adoption and use of HIT in 2007HIT in -2010HIT in and 2012HIT in -2013. We used generalized estimating equations (GEE) to estimate the association of practice characteristics and external incentives with the adoption and use of HIT. We studied 18 measures of HIT functionalities, including record keeping, clinical decision support, patient communication, and health information exchange with hospitals and pharmacies.RESULTS Overall, use of 16 HIT functionalities increased significantly over time, whereas use of 2 decreased significantly. On average, compared with physicianowned practices, hospital-owned practices used 1.48 (95% CI, 1.07-1.88; P <.001) more HIT processes. And relative to smaller practices, practices with 3 to 8 physicians used 2.49 (95% CI, 2.26-2.72; P <.001) more HIT processes. Participation in pay-for-performance programs, participation in public reporting of clinical quality data, and a larger proportion of revenue from Medicare were also associated with greater adoption and use of HIT. CONCLUSIONSThe new Medicare Access and CHIP Reauthorization Act (MACRA) will provide payment incentives and technical support to speed HIT adoption and use by small practices. We found that external incentives were, indeed, positively associated with greater adoption and use of HIT. Our findings also support a strategy of targeting assistance to smaller physician practices and those that are physician owned. Ann Fam Med 2017;15:56-62. https://doi.org/10.1370/afm.1992. INTRODUCTIONI mplementation and use of electronic health records (EHRs) and other health information technology (HIT) has been shown to facilitate primary care practice transformation. [1][2][3][4][5] The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized nearly $30 billion to support the increased adoption and use of HIT throughout the US health care delivery system. 6 In early 2010, the Office of the National Coordinator for Health Information Technology established a nationwide system of regional extension centers to support adoption and use, particularly among small primary care practices.7 Beginning in 2011, the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program offered financial rewards to practices for implementation and meaningful use of EHRs.8 Yet, despite major efforts to expand the adoption and use of HIT, uptake is far from universal. 9 Understanding the factors that influence HIT adoption and use is critical to inform delivery system reform efforts. 57Recent studies of individual physicians have de...

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“…9 Small sample sizes, low occurrence rates, and low volume at most hospitals have further limited the applicability of many measures, adult and pediatric. 10,11 In addition, under careful analysis, even the validity of certain measures, such as postoperative respiratory failure, may be called into question. 12 These concerns have led to calls for even more stringent requirements for national measures, including: (1) strong research foundation (based on >1 study); (2) accurate capture of the evidence base; (3) focus on a process proximate to the outcome of interest; and (4) implementation that has little or no chance of inducing unintended adverse consequences.…”

mentioning

confidence: 99%

Quality Measures in Pediatric Hospital Medicine: Moneyball or Looking for Fabio?

Shen

Percelay²

2012

Hospital Pediatrics

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"What are we doing here?" Brad Pitt asks a table full of weathered scouts in a memorable scene in the movie Moneyball. Playing Oakland Athletics manager Billy Beane, he goes on to critique the scouts' traditional, subjective ranking of players as "looking for Fabio." The fi lm is based on a book of the same name that chronicles the record-breaking success of the 2002 Oakland Athletics baseball team. At the heart of this achievement was the application of novel evidence-based metrics to maximize performance in the setting of a limited supply of fi scal resources.Optimizing value has evolved into a larger movement in sports, and quality measurement in medicine would be envious of a similar trajectory. Although reporting and regulatory requirements in medicine have increased in recent years, our metrics remain crude, often with an inability to attribute value to distinct players. Within pediatrics, hospital-based measures comprise <5% of the total available measures, despite the fact that inpatient care accounts for 40% of pediatric health care spending.1 Of the specifi c pediatric measures endorsed by the National Quality Forum for use in the inpatient setting (Table 1), 2-5 few have relevance to the bulk of daily care provided by pediatric hospitalists.The measures that are the most relevant to pediatric hospital medicine (PHM), the Joint Commission's Children's Asthma Care (CAC) core measures for inpatient asthma, have recently been called into question in light of a large study that revealed no immediate link between components of the measures and readmission rates for asthma.6 Although many hospitals, over time, increased compliance with the home management plan of care requirement, readmission rates did not budge. Thus, there was systems-level process improvement but no change in outcome. Meanwhile, compliance rates for reliever and systemic corticosteroid use were too high to analyze potential relation with outcomes; measurement refl ected high performance but could not drive improvement. This study raises larger questions about the "how" and "why" of quality metrics.There are many reasons why the quality of care should be measured:• Improvement • Meeting standards • Comparisons (for consumers/purchasers of health care) www.hospitalpediatrics.org

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Relationship of Primary Care Physicians' Patient Caseload With Measurement of Quality and Cost Performance

Cited by 52 publications

References 19 publications

Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes

Small And Medium-Size Physician Practices Use Few Patient-Centered Medical Home Processes

Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study

Quality Measures in Pediatric Hospital Medicine: Moneyball or Looking for Fabio?

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