The Changing Landscape Of Primary Care: Effects Of The ACA And Other Efforts Over The Past Decade

Peikes, Deborah; Taylor, Erin Fries; O’Malley, Ann S.; Rich, Eugene C.

doi:10.1377/hlthaff.2019.01430

Cited by 15 publications

(21 citation statements)

References 15 publications

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“…We then compared utilization across rural settings including (1) inpatient stays, (2) emergency department visits, (3) outpatient visits, (4) diabetes quality metrics, (5) mammograms, (6) percentage that died, and (6) payments (Table 4).…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5] Pressure on primary care clinicians to assume responsibility for population health, outcomes, and costs has increased over the past decade. [6][7][8] Despite the recognition that high-quality primary care is an important determinant of health, problems persist: access to primary care is uneven, 9 supply of primary care physicians is decreasing, 10,11 patients are increasingly complex, [12][13][14] and primary care is under-resourced. There are just 3 primary care physicians per 10,000 people in non-metropolitan areas compared with 8 in metropolitan areas.…”

Section: Introductionmentioning

confidence: 99%

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Configuration and Delivery of Primary Care in Rural and Urban Settings

et al. 2022

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Background There are concerns about the capacity of rural primary care due to potential workforce shortages and patients with disproportionately more clinical and socioeconomic risks. Little research examines the configuration and delivery of primary care along the spectrum of rurality. Objective Compare structure, capabilities, and payment reform participation of isolated, small town, micropolitan, and metropolitan physician practices, and the characteristics and utilization of their Medicare beneficiaries. Design Observational study of practices defined using IQVIA OneKey, 2017 Medicare claims, and, for a subset, the National Survey of Healthcare Organizations and Systems (response rate=47%). Participants A total of 27,716,967 beneficiaries with qualifying visits who were assigned to practices. Main Measures We characterized practices’ structure, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Key Results Rural practices were smaller, more primary care dominant, and system-owned, and had more beneficiaries per practice. Beneficiaries in rural practices were more likely to be from high-poverty areas and disabled. There were few differences in patterns of outpatient utilization and practices’ care delivery capabilities. Isolated and micropolitan practices reported less engagement in quality-focused payment programs than metropolitan practices. Beneficiaries cared for in more rural settings received fewer recommended mammograms and had higher overall and condition-specific readmissions. Fewer beneficiaries with diabetes in rural practices had an eye exam. Most isolated rural beneficiaries traveled to more urban communities for care. Conclusions While most isolated Medicare beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care. Rural practices reported similar care capabilities to urban practices, suggesting that despite differences in workforce and demographics, rural patterns of primary care delivery are comparable to urban.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Configuration and Delivery of Primary Care in Rural and Urban Settings

et al. 2022

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“…Data collection and the study protocol were approved by the Institutional Review Board at the University of Pennsylvania and are described elsewhere. 25 The requirement for informed consent was waived because the research team was interested in the healthcare system overall, and the confidentiality of individual practices was protected. The study’s sponsor, the Robert Wood Johnson Foundation, was not involved in the design or conduct of this study, the preparation of this manuscript, or the decision to submit this manuscript for publication.…”

Section: Methodsmentioning

confidence: 99%

“… 26 Eligible offices had to have at least 1 primary care physician (PCP) who served working-age adults, and were in-network by insurance type, which was determined using a survey conducted prior to the audit study. 25 Practices could receive multiple calls from callers with different insurance types.…”

Section: Methodsmentioning

confidence: 99%

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Price Transparency for Primary Care Office Visits and Routine Tests: Results From a 2016 Audit Study

Batra

Candon

2022

INQUIRY

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Introduction: Price transparency is a central component of the shift from volume to value in healthcare delivery. Price transparency in primary care, the most common point of contact with the healthcare system for patients in the U.S., has not been widely studied. Methods: Using an audit study across 10 states in 2016, we examined the characteristics of primary care practices that were able to provide price information for office visits and routine tests. Results: Most primary care practices were able to disclose some price information for office visits and routine tests. Results indicate that larger, integrated primary care practices in urban areas and in areas with a higher percentage of minority residents were less likely to provide prices than smaller, standalone practices. Conclusion: These findings suggest that future efforts to increase price transparency in primary care should be tailored to practice characteristics, including practice location and whether the practice is embedded in an integrated health system.

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Transforming Health Care to Address Value and Equity

Fiscella

Sanders

Carroll

2021

JAMA

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The US health care system is failing to deliver value and equity. 1 Life expectancy has been declining nationally. 1 Health care costs in the United States are the highest in the world. 1 Medicare alternative payment models have yielded modest reductions in costs but have generally not improved health or equity. 2 Fundamental change is needed beyond redesign of alternative payment models. Health care must embrace equitable improvement in the national Vital Signs initiative, invest in primary care, and collaborate with communities. National Vital SignsNational Vital Signs are core metrics produced by the Institute of Medicine (now, the National Academy of Medicine) for tracking improvements in health, health care costs, engagement of the public in its health, and health care and quality. 1 Examples include the percent of adults who are overweight and obese; use of addictive substances including tobacco, alcohol, and illicit drugs; individual engagement in health-related behavior; effective clinical care; and individual well-being. 1,3 National Vital Signs are metrics that matter. Many are behavioral, social, or physiological metrics that powerfully influence health, health care costs, and health disparities. Thus, these metrics are well-suited to guide and motivate health care toward value and equity.

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The Changing Landscape Of Primary Care: Effects Of The ACA And Other Efforts Over The Past Decade

Cited by 15 publications

References 15 publications

Configuration and Delivery of Primary Care in Rural and Urban Settings

Configuration and Delivery of Primary Care in Rural and Urban Settings

Price Transparency for Primary Care Office Visits and Routine Tests: Results From a 2016 Audit Study

Transforming Health Care to Address Value and Equity

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