Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization

Rich, Eugene C.; Peris, Kristanna; Luhr, Marlena; Ghosh, Arkadipta; Molinari, Linda; O’Malley, Ann S.

doi:10.1007/s11606-023-08363-5

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…This study shows that many GPs see a potential for POCUS use in general practice, but the reluctance that some GPs have may be caused by other barriers and concerns than merely financial aspects. Even though studies suggest a high impact of POCUS in the diagnostic process 25 35 and potential cost savings, [36][37][38] evidence supporting POCUS use in general practice is still sparse. More research is needed to explore the non-users' concerns in relation to GPs' ability to obtain and maintain POCUS competence as well as the impact of POCUS on overall patient care including diagnostic test accuracy and patients' prognosis.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics

Andersen,

Brodersen,

Graumann

et al. 2023

BMJ Open

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ObjectiveThe implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs’ concerns related to POCUS use in general practice.DesignAn online survey was distributed in June 2019.SettingGeneral practice.ParticipantsGPs working in office-based primary care clinics in Denmark.Main outcome measuresThe questionnaire was developed using mixed methods and included questions about participants’ characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs’ background characteristics and POCUS use was tested using logistics regression.ResultsResponses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future.ConclusionAlthough, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs’ capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.

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Section: Implications For Research and Practicementioning

confidence: 99%

Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics

Andersen,

Brodersen,

Graumann

et al. 2023

BMJ Open

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“…There is robust evidence suggesting adverse impacts of physicianhospital integration on prices, [11][12][13] utilization, [14][15][16] and quality. 17,18 Studies also suggest PCPs affiliated with health systems may have poorer performance on key primary care quality indicators 19,20 including care fragmentation. 21 As PCP-hospital integration plays a significant role in US health care, it is imperative that researchers leverage the most accurate sources of information available to measure both levels and changes in integration to inform policy.…”

Section: Introductionmentioning

confidence: 99%

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

Chatrath,

Rich,

O'Malley

et al. 2024

Health Services Research

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ObjectiveTo test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims.Data Sources and Study SettingMedicare fee‐for‐service claims, IQVIA, and CPC+ practice surveys for this study.Study DesignWe compare measures of integration from Medicare claims to self‐reported indicators of integration from IQVIA and a survey of CPC+ participating practice sites.Data Collection/Extraction MethodsWe measure integration by using site‐of‐service billing in the 100% sample of Medicare Carrier claims from 2017–2020. In the IQVIA SK&A (2017–2018), OneKey (2019–2020), and practice survey data (2017–2019), we use self‐reported responses to measure integration.Principal FindingsWe find that currently most PCP practices sites that report themselves as being integrated with a health system do not bill as an HOPD. In 2017, 11% of CPC+ practices were identified as being vertically integrated in claims, while the equivalent numbers in SK&A and surveys were 52% and 54% integration, respectively. A t‐test found that both datasets significantly differed from claims (Survey: 41.3%–45.1%; SK&A: 45.3%–51.1%); this gap persists in 2018–2019.ConclusionMeasuring physician‐hospital vertical integration accurately is integral to determining consolidation. The overwhelming majority of PCP practice sites not billing as an HOPD may reflect Medicare regulatory changes that have reduced the financial incentives for doing so. These findings have implications for researchers that study the growth in PCP‐hospital integration in health care markets.

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Emerging Domains for Measuring Healthcare Delivery with Electronic Health Record Metadata (Preprint)

Tawfik,

Rule,

Alexanian

et al. 2024

Preprint

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UNSTRUCTURED This article aims to introduce emerging measurement domains made feasible through electronic health record (EHR) use metadata, to inform the changing landscape of healthcare delivery. We reviewed domains in which EHR metadata may be used to measure healthcare delivery, outlining a framework for evaluating measures based on desirability, feasibility, and viability. We argue that EHR use metadata may be leveraged to develop and operationalize novel measures in the domains of Team Structure and Dynamics, Workflows, and Cognitive Environment, to provide a clearer understanding of modern healthcare delivery. By enabling measures that can be used to inform the next generation of healthcare delivery, EHR use metadata may be used to improve the quality of patient care and support clinician well-being. Careful attention is needed to ensure these measures are desirable, feasible, and viable.

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Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization

Cited by 3 publications

References 11 publications

Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics

Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics

Hospital outpatient department billing is a poor indicator of primary care practice integration with hospital systems

Emerging Domains for Measuring Healthcare Delivery with Electronic Health Record Metadata (Preprint)

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