Physician Group Practice Research Articles

Adoption and Implementation of Strategies for Diabetes Management in Primary Care Practices

Secondary and tertiary prevention of chronic illness is a major challenge for the United States healthcare system. Controlled studies show that interventions can enhance secondary prevention in primary care practices, but they shed little light on implementation of secondary prevention outside the experimental context. This study examines the adoption and implementation of an important set of secondary and tertiary prevention efforts--diabetes management strategies--for type 2 diabetes in the everyday clinical practice of primary care. It explores whether adoption and implementation processes differ by type of strategy or prevalence of diabetes among patients in the practice. Holistic case studies (those used to assess a single analytic unit, in this case, the physician group practice, as opposed to multiple embedded subunits) were conducted in 2001-2002 on six primary care practices in North Carolina identified from a statewide physician survey on strategies for diabetes management. Practices were selected by prevalence of diabetes and type of strategy for diabetes management--patient oriented (focused on self-management) versus biomedical (focused on secondary prevention practices). Results were derived from thematic analysis of interviews and secondary documents. Adoption and implementation did not differ by diabetes prevalence or type of diabetes strategy. All practices had a routine forum for vetting new strategies, and most used traditional channels for identifying them. Implementation often required adaptation of the strategy and the organization. Sustained use of a diabetes strategy depended on favorable organizational policies and procedures (e.g., training, job redesign) and ongoing commitment of resources. Diabetes management strategies are often complex and require adoption and implementation processes different from those described by classic innovation diffusion models. Alternative conceptual models that consider organizational process, structure, and culture are needed.

Practical Issues in the Design and Implementation of Pay-for-Quality Programs

Health plans, healthcare purchasers, and provider organizations throughout the United States are crafting pay-for-performance programs with the intent of improving the quality of care and with recognition of the need to restrain rapidly rising costs. Health plans and large, self-insured employers have typically led the movement toward using quality scorecards with which to gauge hospital and physician performance, coupled with the use of financial incentives directed at hospitals, physician group practices, and individual physicians and practice teams. In this article we provide a conceptual perspective for understanding the objectives and constraints of payers and providers as they wrestle with the next generation of pay-for-quality (P4Q) programs. We identify a set of practical issues that must be addressed in developing and conducting P4Q programs in different market environments. Those issues include specific strategies for choosing quality metrics, units of accountability, size of incentive, data and measurement systems, payout formulas, and collaboration among payers. We illuminate these issues by considering different approaches in light of real-world P4Q demonstrations underway in the Rewarding Results program, in Bridges to Excellence program, and in specific provider organizations we interviewed over the years. The discussion of practical issues highlights principles and examples directly relevant to hospitals and physician organizations that are considering participation in P4Q as well as to those reexamining their physician compensation mechanisms.

An analysis of patient house calls in the area of Attica, Greece

BackgroundPhysicians house calls to patients have been declining in many countries of the world. The objective of this study was to describe the patterns of utilization of house call services provided by SOS doctors in the area of Attica, Greece.MethodsWe performed a retrospective analysis of data regarding house call visits of patients in the area of Attica (metropolitan area of Athens and surrounding cities), Greece. Characteristics of patients who received house call services by a physician, including diagnosis, and recommended management plan, including advice for hospitalization were analyzed.ResultsSOS doctors in the area of Attica, Greece performed 98,009 house calls during the 5-year study period (1/11/2000 – 31/10/2005). Patients older than 65 yeas requested 47.8% of the house calls. Females requested more house calls during the studied period compared to males (59.4% versus 40.6%, p < 0.001). The majority of the diagnoses (18.4%) were infections of the upper and lower respiratory tract. 9.1% of patients were advised after the evaluation at home to be admitted to a hospital to receive inpatient services.ConclusionOur analysis documents the utilization of house calls by SOS doctors in the area of Attica, Greece during a 5-year period. We believe that house calls provided by individual practitioners, physician group practices, or organized companies and organizations should re-gain their well-deserved position in the modern health care systems.

Who Pays? The Incidence of High Malpractice Premiums

This paper uses data from physician group practice to examine the relationship between malpractice premium levels and physician net incomes for the years 1994, 1998, and 2002, a period in which malpractice premiums rose rapidly. We find, as did work covering earlier periods of premium growth, that physician net incomes were not reduced by high or rising premiums, and that gross practice revenues were higher when premiums were higher. There is evidence that this forward shifting of costs was associated more with higher quantities of services than with higher unit fees.

Organizational culture and physician satisfaction with dimensions of group practice.

To assess the extent to which the organizational culture of physician group practices is associated with individual physician satisfaction with the managerial and organizational capabilities of the groups. Physician surveys from 1997 to 1998 assessing the culture of their medical groups and their satisfaction with six aspects of group practice. Organizational culture was conceptualized using the Competing Values framework, yielding four distinct cultural types. Physician-level data were aggregated to the group level to attain measures of organizational culture. Using hierarchical linear modeling, individual physician satisfaction with six dimensions of group practice was predicted using physician-level variables and group-level variables. Separate models for each of the four cultural types were estimated for each of the six satisfaction measures, yielding a total of 24 models. SAMPLE STUDIED: Fifty-two medical groups affiliated with 12 integrated health systems from across the U.S., involving 1,593 physician respondents (38.3 percent response rate). Larger medical groups and multispecialty groups were over-represented compared with the U.S. as a whole. Our models explain up to 31 percent of the variance in individual physician satisfaction with group practice, with individual organizational culture scales explaining up to 5 percent of the variance. Group-level predictors: group (i.e., participatory) culture was positively associated with satisfaction with staff and human resources, technological sophistication, and price competition. Hierarchical (i.e., bureaucratic) culture was negatively associated with satisfaction with managerial decision making, practice level competitiveness, price competition, and financial capabilities. Rational (i.e., task-oriented) culture was negatively associated with satisfaction with staff and human resources, and price competition. Developmental (i.e., risk-taking) culture was not significantly associated with any of the satisfaction measures. In some of the models, being a single-specialty group (compared with a primary care group) and a group having a higher percent of male physicians were positively associated with satisfaction with financial capabilities. Physician-level predictors: individual physicians' ratings of organizational culture were significantly related to many of the satisfaction measures. In general, older physicians were more satisfied than younger physicians with many of the satisfaction measures. Male physicians were less satisfied with data capabilities. Primary care physicians (versus specialists) were less satisfied with price competition. Some dimensions of physician organizational culture are significantly associated with various aspects of individual physician satisfaction with group practice.

German ambulatory care physicians' perspectives on clinical guidelines – a national survey

BackgroundThere has been little systematic research about the extent to which German physicians accept or reject the concept and practice ofa) clinical practice guidelines (CPG) andb) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice.MethodsStructured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables.ResultsOf the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care.ConclusionDespite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

CMS Expands Opportunities for Physicians to Earn Quality Improvement Peformance Payments

Medicare has expanded opportunities for physicians to earn performance payments for improving quality. Effective March 22, 2006 the Centers for Medicare and Medicaid Services (CMS) is making available the shared savings payment model and quality measurement and reporting processes used in the Medicare Physician Group Practice Demonstration (PGP) to Medicare Health Care Quality (MHCQ) Demonstration applicants. The PGP models give applicants a defined and industry supported payment model and quality measurement and reporting process. “We are making the shared savings model and quality reporting tools available so physician groups and health care systems can focus their resources on system redesign to improve patient safety, enhance quality, increase efficiency, and reduce scientific uncertainty and unwarranted variation,” says CMS Administrator Dr. Mark B. McClellan. He notes that the PGP Demonstration shared savings model provides additional financial support for physicians to improve the quality and efficiency of health care services delivered to Medicare fee-for-service beneficiaries. Under this model, according to CMS, physician groups are eligible for performance payments derived from savings from better care management “designed to anticipate patient needs, prevent chronic disease complications, and avoidable hospitalizations, and improve quality of care.” In turn, physicians can use these savings to invest in health IT, care coordination, and other steps to improve care and reduce costs. The MHCQ Demonstration focuses on major and multifaceted system redesign to improve quality and increase efficiency across an entire health care system. “We are seeing physician groups invest in care management programs, redesign clinical care processes, and improve care transitions to better support chronically ill and complex Medicare patients all as a result of the opportunity to share in savings,” McClellan says. “Our patients receive better care when providers are given financial incentives to deliver the right care at the right time in the right setting,” he adds, noting that “physicians know this is the right thing to do for their patients, and now Medicare is providing better financial support to help make it happen, rather than just paying more for more services.” As to eligibility, CMS says physician groups, integrated delivery systems, and regional coalitions thereof are eligible to use the PGP model. Newly formed regional coalitions of smaller physician groups could come together for demonstration purposes to participate in the MHCQ Demonstration using the PGP model. CMS points out that applicants using the PGP model are required to meet all MHCQ goals and objectives (eg, improve patient safety, enhance quality, increase efficiency, reduce scientific uncertainty and unwarranted variation) and have 150 or more physicians. In addition, 100% of the shared savings will be tied to achieving quality thresholds or improvement targets. Providers under a PGP-model MHQX demonstration have flexibility in how they achieve these improvements in care, and they continue to bill Medicare for their services. Applicants interested in the PGP model should submit a letter of intent to CMS by April 28, 2006. The letter of intent should include a brief outline of the demonstration proposal, description of proposed organizational structure, and timeline for developing and implementing the model. MHCQ applicants focused on other redesign initiatives and payment models should continue their efforts. MHCQ-PGP Model applications must be received on or before 5pm EDT on September 29, 2006. More information can be found on the MHCQ Demonstration webpage at http://www.cms.hhs.gov/DemoProjectsEvalRpts/. Click on “Medicare Demonstrations” in the box on the upper left hand side of the screen. Scroll down to “MMA 646: Medicare Health Care Quality Demonstration” in Year 2005.

Pay-for-Performance: At Last or Alas?

Pay-for-Performance: At Last or Alas?

Assessment of internet use and effects among healthcare professionals: a cross sectional survey

Purpose: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians’ perspective on evolving internet environment is lacking. The purpose of...

Differences in practice income between solo and group practice physicians

An examination of the distribution of physician incomes between different types of practices could help policymakers and researchers alike to gain an understanding of the effects of different organizational characteristics of practices on the practice of medicine as a whole. This study uses a national database to explore the relationships that exist between practice incomes and practice types vis-à-vis the overall size of practices. The primary data source for this study, which includes 7757 office-based physicians, was provided by the Taiwan Department of Health (DOH), with the dependent variable of interest to this study being the annual gross income of physician practices, while the independent variables are physician practice types and the number of physicians within a clinic. Multiple regression analyses were used to model the logarithm of annual physician practice incomes as a linear function of a set of independent variables. Kruskal–Wallis test results revealed the existence of significant relationships between practice incomes and practice types ( p < 0.001) and the number of physicians within a clinic ( p < 0.001). Multiple regression analysis also showed that after adjusting for socio-demographic and professional characteristics, the annual incomes of physicians in both single-specialty or multi-specialty group practices ( p < 0.001) were higher than those of their solo practice counterparts. This study concludes that after adjusting for other factors, higher practice incomes are enjoyed by physicians in single-specialty or multi-specialty group practices as compared to their solo practice counterparts. The finding of higher incomes for those physicians organized into groups supports the policy call from the DOH in Taiwan for the widespread formation of group practices.

Clinical Impact of a Pharmacist-Managed Diabetes Mellitus Drug Therapy Management Service

To evaluate the impact of clinical pharmacist interventions, including drug therapy management, on outcomes relevant to diabetes mellitus. Retrospective chart review. Ambulatory, multispecialty physician group practice within a managed care environment in suburban Chicago, Illinois. Three hundred sixteen patients aged 18 years or older, with a diagnosis of diabetes mellitus (89% with type 2), who were referred to a clinical pharmacy service. Drug therapy management and education service provided by a clinical pharmacist. Data were collected for glycosylated hemoglobin A(1c) (A1C), blood pressure, and low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride concentrations. Data also were collected regarding patient adherence with American Diabetes Association guidelines for preventive care, including annual eye and foot examinations, influenza shots, and daily aspirin use at both baseline and follow-up. Mean +/- SD A1C reduction was 1.4% +/- 1.94% (p<0.001); the percentage of patients whose A1C was at goal level at baseline (< 7%) increased from 14.8% to 43.2% (p<0.001). Mean +/- SD LDL level reduction was 14 +/- 41.1 mg/dl (p=0.002), mean +/- SD triglyceride level reduction 42 +/- 97.6 mg/dl (p<0.001). The percentage of patients who reached goal for LDL level (< 100 mg /dl), HDL level (> 40 mg/dl), and blood pressure (< 130/80 mm Hg) did not increase significantly from baseline, whereas those who reached the triglyceride level goal (< 150 mg/dl) increased from 36% to 55% (p<0.005). Frequency of annual dilated retinal examinations and monofilament foot examinations increased by 29% (p<0.05) and 12.5% (p<0.05), respectively. Daily aspirin use increased from 35% to 59% (p<0.05). Significant clinical improvement occurred in patients referred to the pharmacist in a diabetes drug therapy management program.

Determinants of Radiologists’ Productivity in Private Group Practices in California

The purpose of this study was to determine factors that would affect radiologists' productivity in private group practices in California. Individual productivity data were collected for 236 private practice radiologists from 6 private radiology groups in California. The data included information on physician characteristics, facility indicators, and group practice factors that were hypothesized to affect providers' productivity. Statistical tests including chi-square testing and multivariate linear regression were used to analyze the effect of the 3 groupings of factors on the productivity of the radiologists. With increases in age, the number of years in practice, and the number of years in affiliation with the group practice, productivity seemed to decrease. On the other hand, productivity tended to increase if a radiologist was a shareholder, with an increase in the number of facilities served by the radiologist per day, in the proportion of imaging examinations and interventional procedures conducted, and in the proportion of those examinations stored in picture archiving and communication systems. To improve radiologists' productivity, group practices must invest in data-reporting infrastructure for tracking productivity, contract with outpatient imaging centers, and review group practice partnership composition and incentive models to ensure higher productivity. Future studies might consider examining the effect of other factors, such as time spent on nonclinical duties and the use of paramedical assistants in the practice.

Diabetes Management in Canada: Baseline Results of the Group Practice Diabetes Management Study

ABSTRACT BACKGROUND There exists a considerable gap between best practice as rec-ommended by diabetes guidelines and actual practice. The objective of this study was to determine the level of care being provided to patients with type 2 diabetes by family physicians in group practices in 4 regions of Canada. METHODS Baseline characteristics from a cluster-randomized trial using chart audits were recorded to assess glycemic control and rates of physician adherence to guidelines-recommended practice. Intracluster correlation coefficients (ICCs) were calculated using the physician practice as the cluster. RESULTS Fifty-six physicians in 16 group practices provided 549 charts. Glycosylated hemoglobin (A1C) was measured in 71.8% of patients (mean: 7.7%). A total of 82.3% received antihyperglycemic medication, but only 35.3% achieved an A1C INTERPRETATION Despite high rates of screening for glycemia and macrovascu-lar complications, treatment was not sufficiently intensive for most patients. Family physicians performed poorly in microvascular complication screening.

AMA Delegates Bash New Medicare Reporting System

AMA Delegates Bash New Medicare Reporting System

Integrating quality with risk financing through a risk retention group

In Philadelphia, one of the nation's judicial battlegrounds, a clinical practice group of 360 physicians responded to the medical malpractice insurance crisis by creating a reciprocal risk retention group that has supported the group's best practices while almost eliminating the number of claims going to trial. This article describes how the insurance crisis helped change the culture of its physician practice group, restore the close physician-patient relationship that lies at the heart of medicine, and shows how elements of this revolutionary program can be adopted by all professional liability insurers.

The Association of Community Cancer Centers: Providing Advocacy and Education for the Multidisciplinary Cancer Care Team.

Since its inception more than 30 years ago, the Association of Community Cancer Centers (ACCC) has been an active voice for quality cancer care in our nation’s communities. ACCC uniquely represents the cross section of the cancer-care team. The membership of ACCC includes hospital-based cancer programs, physician-group practices, and individual medical oncologists, radiation oncologists, surgeons, nurses, pharmacists, social workers, and cancer program and practice administrators.

Pay for Performance: At Last or Alas?

Pay for Performance: At Last or Alas?

Primary care physicians, office-based practice, and the meaning of quality improvement

Primary care physicians, office-based practice, and the meaning of quality improvement

Health Care Property Investors, Inc.

AbstractProperty, Real Estate &amp; Development (MIC: 8.3 SIC: 6798 NAIC:525930)Health Care Property Investors is a real estate investment trust that invests in healthcare‐related facilities throughout the United States, including long‐term care facilities, congregate care and assisted living facilities, acute care and rehabilitation hospitals, medical office buildings and physician group practice clinics. Co.'s investment portfolio as of Dec 31 2003 included 554 facilities in 44 states. Co.'s investments included 173 long‐term care facilities, 124 retirement and assisted living facilities, 196 medical office buildings, 31 hospitals and 30 other health care facilities.

Health Care Property Investors, Inc.

Mergent's Dividend AchieversVolume 2, Issue 2 p. 131-131 U.S. Company Report Health Care Property Investors, Inc.† First published: 22 April 2005 https://doi.org/10.1002/div.2302 † Contact: : Kenneth B. Roath — Chmn. Address: : 4675 MacArthur Court, Suite 900, Newport Beach, CA 92660 Web Site: : www.hcpi.com AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Property, Real Estate & Development (MIC: 8.3 SIC: 798 NAIC: 25930) Health Care Property Investors is a real estate investment trust that invests in healthcare-related facilities throughout the United States, including long-term care facilities, congregate care and assisted living facilities, acute care and rehabilitation hospitals, medical office buildings and physician group practice clinics. Co.'s investment portfolio as of Dec 31 2003 included 554 facilities in 44 states. Co.'s investments included 173 long-term care facilities, 124 retirement and assisted living facilities, 196 medical office buildings, 31 hospitals and 30 other health care facilities. Volume2, Issue2Spring 2005Pages 131-131 RelatedInformation