The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients.

Introduction: Restructuring primary care is essential to achieve the triple aim. This case study examines the human factors of extensive redesign on 2 midsized primary care clinics (clinics A and B) in the Midwest United States that are owned by a large health care system. The transition occurred when while the principles for patient-centered medical home were being rolled out nationally, and before the Affordable Care Act.

The role of nurse practitioners in primary healthcare.

Objectives: The employment of more nurse practitioners (NPs) is one of the most promising ways to expand the capacity of medical group practices. The objective of this study was to determine the association of NPs with patient-level cost and quality of care.

Study Design: Eighty-five primary care medical group practices were matched with 315,000 Medicare patients.

The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

Background: Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators.

Purpose: To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States.

Methodology: We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators.

A day in the life of an urban emergency department.

Importance: The annual number of patient visits to emergency departments (EDs) continues to increase. Patients seen in the ED for nonemergent conditions potentially increase the cost of health care and lead to overcrowding in EDs.

Objective: To gain insights into the factors leading to nonemergent use of hospital EDs.

The relationships of physician practice characteristics to quality of care and costs.

Background: 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.

Methods: 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.

Do integrated health care systems provide lower-cost, higher-quality care?

A study Looking at quality and cost issues for integrated vs. non integrated physician practices yields some interesting findings.

Medical group practice characteristics influencing inappropriate emergency department and avoidable hospitalization rates.

The inappropriate use of emergency departments (EDs) and ambulatory care sensitive hospital admission rates by patients attributed to a national sample of 212 medical group practices is documented, and the characteristics of practices that influence these rates are identified. Hospital-owned practices have higher nonemergent and emergent primary care treatable ED rates and higher ambulatory care sensitive hospitalization rates. Practices with electronic health records have lower inappropriate ED rates but those in rural areas have significantly higher rates.

Sources of information used in selection of surgeons.

Objectives: We explored the process of physician selection, focusing on selection of surgeons for knee and hip replacement to increase the probability of a new relationship, making cost and quality scorecard information more relevant.

Study Design: We collected data using a mailed survey sent to patients with knee or hip replacement surgery shortly after March 1, 2010. This time period followed a period of publicity about the new cost and quality scorecard.

Medical groups can reduce costs by investing in improved quality of care for patients with diabetes.

A major feature of many new contracts between providers and payers is shared savings programs, in which providers can earn a percentage of the savings if the cost of the care they provide is lower than the projected cost. Unless providers are also held accountable for meeting quality benchmarks, some observers fear that these programs could erode quality of care by rewarding only cost savings. We estimated the effects on Medicare expenditures of improving the quality of care for patients with diabetes.

Factors influencing electronic clinical information exchange in small medical group practices.

Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas.

Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange with other health care providers and to identify the factors influencing those patterns.

Findings: HIE was found to be largely limited to exchanging immunization data through the state health department and exchanging clinical information within owned provider systems.

Market power and contract form: evidence from physician group practices.

We examine how the market power of physician groups affects the form of their contracts with health insurers. We develop a simple model of physician contracting based on 'behavioral economics' and test it with data from two sources: a survey of physician group practices in Minnesota; and the physician component of the Community Tracking Survey. In both data sets we find that increases in groups' market power are associated with proportionately more fee-for-service revenue and less revenue from capitation.

Differences in the cost of health care provided by group practices in Minnesota.

This article reports the findings of a study designed to identify differences in the cost and quality of care provided by medical group practices in Minnesota. Fifty-three practices that provide services to enrollees of employer-based self-insured health plans were included in the study. Costs adjusted for case mix and payment levels were found to vary from $2,400 to nearly $4,700 per member per year.

Health information exchange: participation by Minnesota primary care practices.

Background: The American Recovery and Reinvestment Act of 2009 will provide $36 billion to promote electronic health records and the formation of regional centers that foster community-wide electronic health information exchange (HIE) with the ultimate goal of a nationwide health information network. Minnesota's e-Health Law, passed in 2007, mandates electronic health record and HIE participation by all clinics and hospitals. To achieve these goals, small primary care practices must participate.

Is patient satisfaction influenced by the intensity of medical resource use by their physicians?

Objective: To determine whether patients' satisfaction with their primary care is related to providers' use of medical resources.

Study Design: Sixty-two practices serving 2805 patients enrolled in BlueCross BlueShield of Minnesota were analyzed using hierarchical regression models.

Methods: Three measures of satisfaction included patient satisfaction with overall healthcare, patient satisfaction with the time spent with a physician or other provider during a visit, and the likelihood that a patient would recommend the clinic to others.

Factors influencing physician use of clinical electronic information technologies after adoption by their medical group practices.

Background: A major factor limiting efficiency and quality gains from clinical information technologies is the lack of full use by the clinicians.

Purpose: To identify the practice and physician characteristics that influence the use of e-scripts after adoption.

Methods: Data were obtained from 27 primary care medical group practices that had e-script technology for 2 years.

The effect of the fit between organizational culture and structure on medication errors in medical group practices.

Background: It is widely acknowledged that many prescription drug errors occur in the ambulatory care setting and that they have serious quality of care implications. Previous research examining this issue has focused on hospitals and on individual-level factors. This study adopts an organizational perspective to assess the effects of organizational culture, organizational structure, and their fit (i.

Medical groups' adoption of electronic health records and information systems.

We surveyed a nationally representative sample of medical group practices to assess their current use of information technology (IT). Our results suggest that adoption of electronic health records (EHRs) is progressing slowly, at least in smaller practices, although a number of group practices plan to implement an EHR within the next two years. Moreover, the process of choosing and implementing an EHR appears to be more complex and varied than we expected.

Measuring the culture of medical group practices.

Objective: To develop an instrument that can be used to assess the organizational culture of medical group practices.

Data Sources And Study Setting: Study participants were primary care physicians in 267 medical group practices. The iterative process began in Minnesota and then expanded to practices in 21 other states.

The influence of the structure and culture of medical group practices on prescription drug errors.

Background: This project was designed to identify the magnitude of prescription drug errors in medical group practices and to explore the influence of the practice structure and culture on those error rates. Seventy-eight practices serving an upper Midwest managed care (Care Plus) plan during 2001 were included in the study.

Methods: Using Care Plus claims data, prescription drug error rates were calculated at the enrollee level and then were aggregated to the group practice that each enrollee selected to provide and manage their care.

Assessing the influence of incentives on physicians and medical groups.

This article describes issues that should be considered in the development of a theory or theories about incentives from which testable hypotheses could be derived. Economic, psychological, and organizational theories are described, and issues that should be considered in hypothesis generation are presented. Psychological factors influencing incentives include decision framing, regret, heuristics, and reinforcements.