Practice Ownership Research Articles

Comparison of Populations Served in Hospital Service Areas With and Without Comprehensive Primary Care Plus Medical Homes

Little is known about the types of primary care practices that have chosen to participate in the Comprehensive Primary Care Plus (CPC+) program or about how participation could affect disparities. To describe practices that joined the CPC+ model and compare hospital service areas with and without CPC+ practices. This comparative cross-sectional study identified 2647 CPC+ practices in round 1 (from January 1, 2017; round 1 is ongoing through 2021). Using IMS Health Care Organization Services data, ownership and characteristics of health systems and practices were extracted. Practices participating in the CPC+ program were compared with practices with similar proportions of primary care physicians (>85%) within the 14 regions designated as eligible to participate by the Centers for Medicare & Medicaid Services. Within eligible regions, hospital service areas with (n = 434) and without (n = 322) 1 or more CPC+ practice were compared. Characteristics compared included area-level population demographics (from the US Census Bureau), health system characteristics (from the IMS Health Care Organization Services), and use of health services by Medicare fee-for-service enrollees (Dartmouth Atlas). Area-level characteristics of all eligible CPC+ regions, areas without a CPC+ practice, and areas with 1 or more CPC+ practices. Of 756 eligible service areas, 322 had no CPC+ practices and 434 had at least 1 CPC+ practice. Of 2647 CPC+ practices, 579 (21.9%) had 1 physician and 1791 (67.7%) had 2 to 10 physicians. In areas without CPC+ practices, the population had a lower median income ($43 197 [interquartile range, $42 170-$44 224] vs $57 206 [interquartile range, $55 470-$58 941]), higher mean share of households living in poverty (17.8% [95% CI, 17.2%-18.4%] vs 14.4% [95% CI, 13.9%-15.0%]), higher mean educational attainment of high school or less (52.7% [95% CI, 51.7%-53.6%] vs 43.1% [95% CI, 42.1%-44.2%]), higher mean proportion of disabled residents (17.7% [95% CI, 17.3%-18.2%] vs 14.2% [13.8%-14.6%]), higher mean participation in Medicare (21.9% [95% CI, 21.3%-22.4%] vs 18.8% [95% CI, 18.3%-19.1%]) and Medicaid (22.2% [95% CI, 21.5%-22.9%]) vs 18.5% [95% CI, 17.8%-19.2%]), and higher mean proportion of uninsured residents (12.4% [95% CI, 11.9%-12.9%] vs 10.3% [95% CI, 9.9%-10.7%]) (P < .001 for all) compared with areas that had a CPC+ practice. According to this study, although a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations.

On political activism in digital games

This project investigates how players of digital games apply their own play with the intent to transmit political messages to other players. Acts of activism are collected from a sample of commercial multiplayer online games; three taxonomies are proposed of which one is used to present the findings, and popular patterns or structures of activism are identified. It is found that in-game activism often takes its cue from activism in everyday life, but that some original topics emerge, for example, the ownership of virtual worlds and practices of in-game political activism such as novel forms of rallies. Current political activism often appears to utilize generic and widely-shared game mechanics, rather than mechanics specific to individual games or genres. Games are therefore selected for their topics, availability, and costs, and popularity with the target audience

Milk and milk products processing, preservation and utilization in Gimbi district, West Wollega zone, Ethiopia

This study was conducted in Gimbi district, West Wollega zone to understand the traditional handling, processing and utilization of milk and milk products. 128 households were selected based on ownership of dairy cows, milk processing, handling, and utilization practice. Accordingly, Lantana trifolia (Kusaayee), Ocimum sanctum (Basoobilaa), Olea Africana (Qoraasuma) and Deinboll (Dabaqqa) were the most commonly cleaning and smoking plant species in the district. Yoghurt-like fermented/sour milk, traditional butter, traditional ghee, cottage cheese (Ayib), buttermilk and whey were the major milk products produced in the district. Women preserve butter by mixing with spices such as Zingiber officinale (Jinjibila), Allium sativum (Qulubbii adii), Ocimum (Siqaqibee) and Trigonella foenum (Sunqoo). Out of the total daily milk produced, most of it was processed (70.5%), 8% was sold while the left was consumed within the household (21.5%). Among milk and milk products produced, only butter was supplied to local markets. Lack of cooling facilities; low volume of milk production; unimproved milk processing materials and limited knowledge on handling and processing of milk and milk products were the major constraints. Recognizing the importance milk and milk products to the producing household nutrition, health and income, development interventions are required to boost production, improve the quality of the products and efficiency of the traditional milk processing equipment.

PD52-01 ASSOCIATION BETWEEN RADIATION FACILITY OWNERSHIP AND VARIATION IN PROSTATE CANCER TREATMENT AND SPENDING

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making III1 Apr 2018PD52-01 ASSOCIATION BETWEEN RADIATION FACILITY OWNERSHIP AND VARIATION IN PROSTATE CANCER TREATMENT AND SPENDING Tudor Borza, Phyllis Yan, Samuel R. Kaufman, Lindsey Herrel, Ted A. Skolarus, Vahakn B. Shahinian, and Brent Hollenbeck Tudor BorzaTudor Borza More articles by this author , Phyllis YanPhyllis Yan More articles by this author , Samuel R. KaufmanSamuel R. Kaufman More articles by this author , Lindsey HerrelLindsey Herrel More articles by this author , Ted A. SkolarusTed A. Skolarus More articles by this author , Vahakn B. ShahinianVahakn B. Shahinian More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2353AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Differences in prostate cancer treatment arise from multiple patient and disease factors. Financial incentives from radiation facility ownership may serve as additional sources of variation. Herein, we characterize the variation in prostate cancer treatment and spending and examine the effect of radiation facility ownership on this. METHODS We used a 20% Medicare sample to perform a retrospective cohort study of men with newly diagnosed prostate cancer between 2010 and 2013. Urologists were categorized by their practice affiliation (single specialty vs. multispecialty group) and ownership of a radiation facility. For single specialty groups, generalized estimating equations adjusting for patient variables were used to calculate rates of treatment within one year of diagnosis, potential overtreatment (i.e. treatment in patients with a 10-year risk of non-cancer mortality exceeding 75%) and annual price standardized per-beneficiary spending. RESULTS We identified 19,063 men who were cared for by urologists affiliated with one of 561 single specialty groups, 88 of which were radiation facility owners. The mean rate of initial treatment was 70% with wide variation noted among groups (range 47%-87%, Figure). The mean rate of potential overtreatment was 44% (range 15%-80%) and mean annual spending was $20,668 (range $12,865-$34,964). Only 16% of radiation facility owning groups had initial treatment rates below the mean while 57% were in the highest quartile with similar trends noted in potential overtreatment. For annual spending, only 11% of radiation facility owning groups were below the mean and 68% were in the highest quartile. CONCLUSIONS We observed wide variation in rates of treatment and spending among single specialty urology groups. The majority of groups with radiation facility ownership had rates of initial treatment, potential overtreatment and annual spending in the highest quartile. Radiation facility ownership appears to play a role in how patients with newly diagnosed prostate cancer are treated. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e980-e981 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Tudor Borza More articles by this author Phyllis Yan More articles by this author Samuel R. Kaufman More articles by this author Lindsey Herrel More articles by this author Ted A. Skolarus More articles by this author Vahakn B. Shahinian More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Exploring the job satisfaction and career progression of musculoskeletal physiotherapists working in private practice in Western Australia

BackgroundDespite increasing workforce numbers, new graduate physiotherapists are reporting short career intentions due to low job satisfaction. Job satisfaction improves retention among allied health professionals, however we have limited understanding of its influence specific to physiotherapists. ObjectivesThe aim of this study was to explore factors contributing to the job satisfaction of musculoskeletal physiotherapists working in private practice across different career stages (new graduates, graduates, postgraduates, and owners) in Western Australia. DesignMixed-methods design with an anonymous self-administered survey capturing job satisfaction and employment characteristics of Western Australian physiotherapists working in private practice. Factors including peer support and mentoring, career progression and professional development were explored. MethodPhysiotherapists were recruited through snowball sampling, with 60 practices approached to participate. Survey results were analysed using linear regression models and basic thematic analysis. ResultsTwo-hundred and five surveys were completed by physiotherapists across 52 practices. The mean job satisfaction score was 41.9 out of 50, and increased job satisfaction was associated with practice ownership, salary satisfaction, established career pathways, and access to mentoring and professional development. ConclusionsPractice owners were significantly more satisfied with their job compared to new graduate, graduate and postgraduate physiotherapists. Findings illustrated the changing needs for support across different career stages, the importance of accessible senior clinicians, and the limited recognition for the efforts made by physiotherapists to pursue ongoing education.

A Novel Group Ownership Delegate Protocol for RFID Systems

In recent years, Radio Frequency Identification (RFID) applications of various kinds have been blooming. However, along with the stunning advancement have come all sorts of security and privacy issues, for RFID tags oftentimes store private data and so the permission to read a tag or any other kind of access needs to be carefully controlled. Therefore, of all the RFID-related researches released so far, a big portion focuses on the issue of authentication. There have been so many cases where the legal access to or control over a tag needs to be switched from one reader to another, which has encouraged the development of quite a number of different kinds of ownership transfer protocols. On the other hand, not only has the need for ownership transfer been increasing, but a part of it has also been evolving from individual ownership transfer into group ownership transfer. However, in spite of the growing need for practical group ownership transfer services, little research has been done to offer an answer to the need. In this paper, we shall present a new RFID time-bound group ownership delegate protocol based on homomorphic encryption and quadratic residues. In addition, in order to provide more comprehensive service, on top of mutual authentication and ownership delegation, we also offer options for the e-th time verification as well as the revocation of earlier delegation.

Veterinary practice ownership, student loan debt, and job fulfillment

Veterinary medicine is a dynamic field that has long enjoyed high rates of personal fulfillment often supported by perceived or achieved social mobility, honor and respect, stable career prospects, and good income potential. However, job satisfaction and career expectations pale in comparison to contemporary veterinary graduates with veterinary student debt levels nearly 200% greater than average starting salaries. This widening income-to-debt ratio has disillusioned modern recent graduates with withering job fulfillment and some exodus from private practice veterinary medicine. However, early career private practice ownership stands out as a viable means to positively direct one’s student debt, work environment, and personal fulfillment.

A Secure and Practical RFID Ownership Transfer Protocol Based on Chebyshev Polynomials

Radio frequency identification (RFID) has a wide range of applications, such as traffic management, access control, and supply chain management. Designing secure and efficient (i.e., practical) ownership transfer schemes remains a topic of ongoing challenge to supply chain vendors. In this paper, we propose the first RFID ownership transfer protocol based on Chebshev polynomials. The exchange properties of Chebyshev polynomials allow our proposed scheme to achieve data integrity, authentication, anonymity, and session freshness. We also demonstrate that our proposed scheme is more efficient than the existing schemes with the same security level, due to the reduced number of interactions.

Characteristics of a stratified random sample of New Zealand general practices.

INTRODUCTION Practice size and location may affect the quality and safety of health care. Little is known about contemporary New Zealand general practice characteristics in terms of staffing, ownership and services. AIM To describe and compare the characteristics of small, medium and large general practices in rural and urban New Zealand. METHODS Seventy-two general practices were randomly selected from the 2014 Primary Health Organisation database and invited to participate in a records review study. Forty-five recruited practices located throughout New Zealand provided data on staff, health-care services and practice ownership. Chi-square and other non-parametric statistical analyses were used to compare practices. RESULTS The 45 study practices constituted 4.6% of New Zealand practices. Rural practices were located further from the nearest regional base hospital (rural median 65.0 km, urban 7.5 km (P < 0.001)), nearest local hospital (rural 25.7 km, urban 7.0 km (P = 0.002)) and nearest neighbouring general practitioner (GP) (rural 16.0 km, urban 1.0 km (P = 0.007)). In large practices, there were more enrolled patients per GP FTE than both medium-sized and small practices (mean 1827 compared to 1457 and 1120 respectively, P = 0.019). Nurses in large practices were more likely to insert intravenous lines (P = 0.026) and take blood (P = 0.049). There were no significant differences in practice ownership arrangements according to practice size or rurality. CONCLUSION Study practices were relatively homogenous. Unsurprisingly, rural practices were further away from hospitals. Larger practices had higher patient-to-doctor ratios and increased nursing scope. The study sample is small; findings need to be confirmed by specifically powered research.

Occupational Licensure and Entrepreneurs: The Case of Tax Preparers in the U.S.

The authors examine the relationship between entrepreneurship and occupational licensure using data on the universe of more than 700,000 tax preparers in the United States. Prior research suggested that occupational licensure has negative effects on entrepreneurship because it increases the costs of operating a business. By contrast, the authors argue that licensure may allow entrepreneurs to signal quality and enhance their legitimacy. States that require tax preparers to be licensed have higher average rates of entrepreneurship—approximated by tax practice ownership—and, in high-income ZIP codes, more demand for paid preparer services. In the analysis of the introduction of a federal license requirement in tax preparation in 2013, voluntary early adoption of the license by preparers predicts higher chances of survival in the industry. Entrepreneurs are less likely to adopt the license early than are non-entrepreneurs, unless they lack other state-level credentials. Results thus suggest that licensure represents a trade-off for entrepreneurs between the costs of obtaining a license and the benefits of signaling quality and legitimacy.

Early career practice ownership

Financial independence is almost considered a pipedream nowadays among veterinary graduates. Years of disproportionate trends in educational costs and starting salaries have created a gargantuan student debt-to-income ratio. One troubling aspect of this multifaceted issue is the concurrent waning of recent veterinary graduates' interest in practice ownership. While private practice ownership has long been a staple of the profession, contemporary early career veterinarians are turning to internships, advanced specialized training, alternative fields, and careers as associate veterinarians. However, while the veterinary student loan debt debate continues, and as recent veterinary graduates have little control over rising educational costs, early career practice ownership is more relevant than ever. Early career practice ownership is a viable option for financial independence. It is also 1 part of the equation that each individual veterinary graduate can control. While early career practice ownership is not for everyone, this career path should garner strong consideration as a means to retire veterinary student loan debt.

Expected Changes in Regulation and Licensure: Influence on Future Education of Dentists.

This article is based on the following assumptions about dental care in the United States: there is an access to oral health care problem; the number of individuals with dental insurance is increasing; the demographics of the dental profession does not mirror the overall demographics of the U.S. population; and emerging oral health workforce models may help improve access to care. Based on these assumptions, this article explores related licensure and regulatory factors that will influence the education and practice of dentists in the future. The issues discussed are licensure of emerging oral health practitioners, mobility of the dental health care workforce, corporate ownership of dental practices, ethical issues related to use of human subjects in dental licensure examinations, interprofessional education and practice, and health care reform. The licensure and regulatory bodies discussed are the Commission on Dental Accreditation (CODA), state legislatures and boards of dentistry, federal legislative activities, judicial activities, and the Federal Trade Commission. Recommendations based on this discussion are presented. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Urologist Practice Affiliation and Intensity-modulated Radiation Therapy for Prostate Cancer in the Elderly

BackgroundProstate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment. ObjectiveTo assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer. Design, setting, and participantsA retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free. InterventionUrologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility. Outcome measurements and analysisUse of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences. ResultsAmong men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p<0.001). Patients managed in groups with IMRT ownership (n=5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p<0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p<0.001) and overall treatment (53% vs 44%, p<0.001) were more likely in groups with ownership than in those without, respectively. ConclusionsUrologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality. Patient summaryWe assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient.

The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement

The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement

Practice ownership is declining

Practice ownership is declining

Health Ethics in Benin and HIV-AIDS: What are the stakes

As part of the fight against HIV-AIDS, an effort was made at the ethical component, namely that there are legal texts, institutional and ethical. There are ethics committees (three) that give reasoned opinions on study protocols and are endeavoring to raise awareness of the actors. But we note that there is not yet a real ownership and adoption of ethical practice by them. This study targeted research projects on HIV-AIDS and centers supported PLHIV in order to analyze ethical issues : 1) the method of recruitment of participants and beneficiaries ; 2) obtaining informed consent from them ; 2) measures of confidentiality and anonymity ; 3) the integrity of staff of these projects and centers and conflicts of interest. A thematic analysis of data collected, which is done, after semi-structured interviews, helped to highlight the issues related to the recruitment process, obtaining informed consent, confidentiality measures and anonymity, integrity and Conflict of Interest. Let us remember that what is done, not done yet in the forms of art. Constant monitoring is called for, as leaders with ethics committees.They are supposed to play fully their roles.

Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

Little is known about the attitudes toward and adoption of telehealth services among family physicians (FPs), the largest primary care physician group. We conducted a national survey of FPs, randomly sampled from membership organization files, to investigate use of and barriers to using telehealth services. Using bivariate analyses, we examined how telehealth usage affected FPs' identified barriers to using telehealth services. Logistic regressions show the factors associated both with using telehealth services and with barriers to using telehealth services. Surveys reached 4980 FPs; 1557 surveys were eligible for analysis (31% response rate). Among FPs, 15% reported using telehealth services during 2014. After controlling for the characteristics of the physicians and their practice, FPs who were based in a rural setting, worked in a practice owned by an integrated health system or other ownership structure, and provided hospital/urgent/emergency care were more likely to use telehealth. Physician and practice characteristics by telehealth use status, sex of the physician, practice location, years in practice, care provided, and practice ownership were associated with the barriers identified. Telehealth use was limited among FPs. Many of the barriers to using telehealth services cited by FPs are amenable to policy modification.

Current Workforce of Pediatric Subspecialists in the United States.

Concerns exist regarding the adequacy of the pediatric subspecialty workforce in the United States. Data on practice patterns and job characteristics are necessary to help develop policies to ensure availability. We performed survey data analysis of all pediatric subspecialists enrolled in Maintenance of Certification in 2013 and 2014, assessing demographic information, characteristics of current positions, plans for retirement, and satisfaction with allocation of professional and clinical responsibilities. Four logistic regression models examined the independent association of demographic variables collected along with variables of practice ownership and academic appointment with the outcome variables of pediatric subspecialists reporting match of desired with current actual professional duties, match of desired with current actual clinical responsibilities, current part-time employment, and expected age of retirement <65 years of age. Data from 5100 subspecialists were analyzed (response rate 87.2%). Most (83%; N = 4251) reported their current allocation of professional time was what they desired in their current position; similarly, 93% (N = 4755) reported likewise for clinical responsibilities. Differences by gender and years in subspecialty were evident, with women much more likely to work part time than men (odds ratio 6.22); those >20 years in practice were less likely to retire before the age of 65 compared with those <10 years in practice (odds ratio 0.33). This study is the largest to date of practicing pediatric subspecialists. Variation in work patterns found between genders, with time in practice, and between subspecialties suggests that future research should focus on these issues.

Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States

Hospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care. To assess the association of hospital location and hospital ownership with the provision of low-value health services. This study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013. Logistic regression models adjusted for patient and health care professional characteristics and year, and weighted results were used to reflect population estimates. Results were also stratified by symptom acuity and whether a generalist physician (eg, general internist or family practitioner) was the patient's primary care provider. This study used nationally representative data from the National Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2013) and the National Hospital Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2011) on outpatient visits to generalist physicians. Participants were patients seen with 3 common primary care conditions, namely, upper respiratory tract infection, back pain, and headache. The use of antibiotics (for upper respiratory tract infection), computed tomography or magnetic resonance imaging (for back pain and headache), radiographs (for upper respiratory tract infection and back pain), and specialty referrals (for all 3 conditions). This study identified 31 162 visits for upper respiratory tract infection, back pain, and headache, representing an estimated 739 million US primary care visits from 1997 to 2013. Compared with visits with community-based physicians, patients in visits to hospital-based physicians were younger (mean age, 44.5 vs 49.1 years; P < .001) and less frequently saw their primary care provider (52.7% vs 81.9%, P < .001). Although antibiotic use was similar in both settings, hospital-based visits had more orders for computed tomography and magnetic resonance imaging (8.3% vs 6.3%, P = .01), radiographs (12.8% vs 9.9%, P < .001), and specialty referrals (19.0% vs 7.6%, P < .001) than community-based visits. Multivariable adjustment and symptom acuity stratification revealed similar findings. Visits with a generalist other than the patient's primary care provider were associated with greater provision of low-value care but mainly within hospital-based settings. Practice patterns were similar among hospital-owned vs physician-owned community-based practices with the exception of specialty referrals, which were more frequent in hospital-owned community-based practices. Visits to US hospital-based practices are associated with greater use of low-value computed tomography and magnetic resonance imaging, radiographs, and specialty referrals than visits to community-based practices, and visits to hospital-owned community-based practices had more specialty referrals than visits to physician-owned community-based practices. These findings raise concerns about the provision of low-value care at hospital-associated primary care practices.

Evaluating The Role Of Payment Policy In Driving Vertical Integration In The Oncology Market

The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003-15, finding that the rate of hospital or health system ownership of practices doubled from about 30percent to about 60percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that dramatically reduced reimbursement for chemotherapy drugs, and the expansion of hospital eligibility for the 340B Drug Discount Program under the Affordable Care Act (ACA). To evaluate the evidence for these explanations, we used difference-in-differences methods to assess whether consolidation increased more in areas with greater exposure to each policy than in areas with less exposure. We found little evidence that either policy contributed to vertical integration. Rather, increased consolidation in the market for cancer care may be part of a broader post-ACA trend toward integrated health care systems.