Physician-owned Practices Research Articles

Increased Use of Care Management Processes and Expanded Health Information Technology Functions by Practice Ownership and Medicaid Revenue.

Practice ownership and Medicaid revenue may affect the use of care management processes (CMPs) for chronic conditions and expansion of health information technology (HIT). Using a national cohort of medical practices, we compared the use of CMPs and HIT from 2006/2008 to 2013 by practice ownership and level of Medicaid revenue. Poisson regression models estimated changes in CMP use, and linear regression estimated changes in HIT, by practice ownership and Medicaid patient revenue, controlling for other practice characteristics. Compared with physician-owned practices, system-owned practices adopted a greater number of CMPs and HIT functions over time (p < .001). High Medicaid revenue (≥30.0%) was associated with less adoption of CMPs (p < .001) and HIT (p < .01). System-owned practices (p < .001) and community health centers (p < .001) with high Medicaid revenue were more likely than physician-owned practices with high Medicaid revenue to adopt CMPs over time. System and community health center ownership appear to help high Medicaid practices overcome CMP adoption constraints.

Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010).

Introduction. Proton pump inhibitors (PPI) are one of the most commonly prescribed medication classes with similar efficacy between brand name and generic PPI formulations. Aims. We determined demographic, clinical, and practice characteristics associated with brand name PPI prescriptions at ambulatory care visits in the United States. Methods. Observational cross sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) of all adult (≥18 yrs of age) ambulatory care visits from 2006 to 2010. PPI prescriptions were identified by using the drug entry code as brand name only or generic available formulations. Descriptive statistics were reported in terms of unweighted patient visits and proportions of encounters with brand name PPI prescriptions. Global chi-square tests were used to compare visits with brand name PPI prescriptions versus generic PPI prescriptions for each measure. Poisson regression was used to determine the incidence rate ratio (IRR) for generic versus brand PPI prescribing. Results. A PPI was prescribed at 269.7 million adult ambulatory visits, based on 9,677 unweighted visits, of which 53% were brand name only prescriptions. In 2006, 76.0% of all PPI prescriptions had a brand name only formulation compared to 31.6% of PPI prescriptions in 2010. Visits by patients aged 25–44 years had the greatest proportion of brand name PPI formulations (57.9%). Academic medical centers and physician-owned practices had the greatest proportion of visits with brand name PPI prescriptions (58.9% and 55.6% of visits with a PPI prescription, resp.). There were no significant differences in terms of median income, patient insurance type, or metropolitan status when comparing the proportion of visits with brand name versus generic PPI prescriptions. Poisson regression results showed that practice ownership type was most strongly associated with the likelihood of receiving a brand name PPI over the entire study period. Compared to HMO visits, patient visits at academic medical centers (IRR 4.2, 95% CI 2.2–8.0), physician-owned practices (IRR 3.9, 95% CI 2.1–7.1), and community health centers (IRR 3.6, 95% CI 1.9–6.6) were all more likely to have brand name PPIs. Conclusion. PPI prescriptions with brand name only formulations are most strongly associated with physician practice type.

Small primary care physician practices have low rates of preventable hospital admissions.

Nearly two-thirds of US office-based physicians work in practices of fewer than seven physicians. It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. What is the relationship between practice size--and other practice characteristics, such as ownership or use of medical home processes--and the quality of care? We conducted a national survey of 1,045 primary care-based practices with nineteen or fewer physicians to determine practice characteristics. We used Medicare data to calculate practices' rate of potentially preventable hospital admissions (ambulatory care-sensitive admissions). Compared to practices with 10-19 physicians, practices with 1-2 physicians had 33 percent fewer preventable admissions, and practices with 3-9 physicians had 27 percent fewer. Physician-owned practices had fewer preventable admissions than hospital-owned practices. In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes, to learn more about how small practices provide patient care, and to learn more about the types of organizational structures--such as independent practice associations--that may make it possible for small practices to share resources that are useful for improving the quality of care.

The National Commission on Physician Payment Reform: Recalibrating Fee-for-Service and Transitioning to Fixed Payment Models

The National Commission on Physician Payment Reform: Recalibrating Fee-for-Service and Transitioning to Fixed Payment Models

Horizontal and vertical integration of physicians: a tale of two tails.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway. DESIGN/METHODOLOGY APPROACH: We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models. The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners. While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization. Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices. Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats. This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.

Declining Proportion of Physician-Owned Practices Possibly Related to Increasing Burnout

Declining Proportion of Physician-Owned Practices Possibly Related to Increasing Burnout

Trends in a changing vascular practice environment for members of the Society for Vascular Surgery

To survey the Society for Vascular Surgery (SVS) membership with regard to practice trends related to work effort, employment status, practice ownership, endovascular cases, and anticipated changes in practice in the near future. A survey questionnaire was developed to gather information about member demographics and practice, hours worked, full-time (FT) or part-time status, employment status, practice ownership, competition for referrals, proportion of endovascular vs open procedures, and anticipated changes in practice in the next 3 years. We used SurveyMonkey and distributed the survey to all active vascular surgeon (VS) members of the SVS. The response rate was 207 of 2230 (10.7%). Two thirds were in private practice, and 21% were in solo practice. Twenty-four percent were employed by hospitals/health systems. Those VS under the age of 50 years were more likely to exclusively practice vascular surgery compared with VS over the age of 50 years (P= .0003). Sixty-eight of the physicians (32.7%) were between 50 and 59 years old, 186 (90.3%) were men, 192 (92.8%) worked FT (>36 hours of patient care per week), and almost two thirds worked >60 hours per week. Those in physician-owned practices worked >40 hours of patient care per week more often than did FT employed VS (P= .012). Younger VS (age<50 years) more frequently reported >50% of their workload being endovascular compared with older VS (age ≥50 years; P< .001). Eighty percent of FT VS planned to continue their current practice over the next 3 years. Of the 43.6% indicating loss of referrals, 82% pointed to cardiologists as the competition. The current workforce is predominately male and works FT; one-third is between the ages of 50 and 59 years. Younger VS (age<50 years) are more likely to exclusively practice VS and have a higher caseload of endovascular procedures. Those in physician-owned practices are more likely to put in >40 hours of patient care per week than are FT employed VS. Longitudinal surveys of SVS members are imperative to help tailor educational, training, and practice management offerings, guide governmental activities, advocate for issues important to members, improve branding initiatives, and sponsor workforce analyses.

The Road Ahead

The Road Ahead

Physicians In Nonprimary Care And Small Practices And Those Age 55 And Older Lag In Adopting Electronic Health Record Systems

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

Commentary: Six Years of Trends in Oncology Practice Data

Six years of accumulated oncology practice financial data are presented in this issue of Journal of Oncology Practice in a report by Barr and Towle.1 Collection and presentation of this potentially sensitive financial information is a remarkable achievement. The authors and their organization (Oncology Metrics, a division of Altos Solutions) conduct yearly surveys of office-based, generally physician-owned practices (the traditional “private practice” or “community practice”) and have previously presented high-level data in JOP (for the most recent benchmark report, please see the upcoming November JOP supplement). Although there are potential biases in the study sampling methodology and analysis (see methodological footnote, Appendix [online only]), this report presents the most current real-world practice data publically available.

Survey of Connecticut Nurse-Midwives

Descriptive data on nurse-midwifery income, workload, job definitions, employment benefits, and clinical practices are limited. Information about nurse-midwifery practice today is important for the growth of the profession and for future policy initiatives. A survey of nurse-midwives in Connecticut was conducted in 2005. This article reports state-specific data about income, workload, job definitions, employment benefits, and clinical issues, such as vaginal birth after cesarean. Full-time midwives in Connecticut worked an average of 77 hours per week, had a mean salary of 79,554 dollars, and 87% had on-call responsibilities. A "typical" Connecticut midwife had an "average" full-time work week consisting of two 24-hour call days and three 7-hour office days, seeing 19 to 24 patients per office day. Most held Master of Science in Nursing degrees, worked in physician-owned practices, and attended births in hospitals or medical centers. Health insurance, paid sick time, and retirement plans were offered to most respondents. Almost all respondents provide gynecologic, antepartum, and postpartum care, but few offer newborn care. There is significant variation in restrictions on midwives offering vaginal birth after cesarean and on length of scheduled appointments. Data on expanded practices, such as first-assisting caesarean sections and endometrial biopsies, are reported for the first time.

Physician Practice Revenues and Use of Information Technology in Patient Care

Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT. We undertook a cross-sectional analysis of data on 6849 U.S. physicians in physician-owned practices who responded to the 2000-2001 Community Tracking Study Physician Survey. Physician practice revenues, measured as the percentage of total revenues, is defined along 2 dimensions: type (capitation, noncapitated managed care, or fee-for-service) and source (Medicare, Medicaid, or private/other). Analyses were adjusted for physician and practice characteristics and geographic location. The proportion of physicians using IT for 5 functions of patient care: treatment guidelines, formularies, patient notes or lists, electronic prescriptions, and data exchange with other physicians. Practice revenues are associated with differences in physicians' use of IT in patient care. Above-average Medicaid revenue was associated with 20% higher use of IT overall (incidence density ratio = 1.20, 95% confidence interval [CI] = 1.12-1.30). Above-average capitation revenue corresponds to higher use of IT overall (incidence density ratio = 1.10, 95% CI = 1.02-1.19) and greater odds of using IT for guidelines (odds ratio = 1.26, 95% CI = 1.05-1.53). Above-average noncapitated managed care revenue, however, has no apparent relationship with IT use. Differences in the type and source of physician revenues were associated with differences in the use of IT in patient care in 2000-2001. The relationships between practice revenues and IT use varied across clinical IT functions.

The Infusion Nurseʼs Role in Precertification

Gibbs Regional Cancer Center, a comprehensive cancer center, is part of the Spartanburg Regional Medical Center located in Spartanburg, South Carolina. Palmetto Hematology Oncology PC, located within the Gibbs Regional Cancer Center, is a private practice infusion therapy center owned by six physicians serving upstate Carolina residents. The practice has been successful in using precertification to confront complex reimbursement issues, complicated treatment methods, and demanding practice measures to ensure quality cancer care for patients. In the past 18 months, Medicare reimbursement guidelines for medications offered to patients at nonhospital infusion outpatient centers have been cut, and the future reimbursement criteria are uncertain. These cutbacks have caused other infusion centers to close or change practice guidelines. Precertification at Palmetto Hematology Oncology PC has trimmed treatment losses, increasing the focus on patients. Precertification of patients is not a new idea, but a new approach involves nurses in the process to help keep physician-owned practices afloat in this insurance-driven market. This article shares the value of precertification in an outpatient infusion center and the role of nurses in this process.

The mirage of available health care for the uninsured

The mirage of available health care for the uninsured

The Mirage of Available Health Care for the Uninsured

The Mirage of Available Health Care for the Uninsured

Strategies for Succeeding in a Changing Environment

I 'm sure that everyone of us-sometime in our careers-has faced a patient with nerve injuries. We know that patient's future is uncertain. The nerve may not regenerate, and the patient may face permanent changes in the way he or she functions. Yet despite those uncertainties, we as therapists have no reservation about continuing to be positive with the patient, because we know that we have the knowledge and the skill to help him or her successfully face the challenges ahead. We need to keep this same attitude as we face the uncertainties in our own professional futures. During the past year, I have enjoyed speaking with many hand therapists, and our conversations have made me aware of how rapidly the major shifts in health care are occurring and how significant the changes are to our profession. For example, I have spoken with private practitioners struggling with decisions of whether to sell their practices to corporate entities. I've met managers faced with laying off employees. And I've talked to hospital rehabilitation directors whose own positions have been phased out in an effort to control costs. I've heard of occupational therapy (OT), physical therapy (PT), and speech therapy private practices forming regional networks to stay competitive. And while occasionally I have heard of physician-owned practices selling to loyal hand therapists, most often I hear that physicians are selling to corporations. So, like many of our patients, we spend a great deal of time and energy focusing on the potential disasters associated with changes in our lives. What I propose is that we take the same positive attitude for ourselves that we give our patients. Remind ourselves that change, uncertainty-and opportunity-walk hand in hand. And let's start today. Let's clear our minds of the fears and concerns that