Practice‐site‐level measures of primary care comprehensiveness and their associations with patient outcomes

Abstract

Objectives: To develop two practice-site-level measures of comprehensiveness and examine their associations with patient outcomes, and how their performance differs from physician-level measures.Data Sources: Medicare fee-for-service claims. Study Design:We calculated practice-site-level comprehensiveness measures (new problem management and involvement in patient conditions) across 5286 primary care physicians (PCPs) at 1339 practices in the Comprehensive Primary Care initiative evaluation in 2013. We assessed their associations with practices' attributed beneficiaries' 2014 total Medicare expenditures, hospitalization rates, ED visit rates. We also examined variation in PCPs' comprehensiveness across PCPs within practices versus between primary care practices. Finally, we compared associations of practice-site and PCP-level measures with outcomes.

Primary Care Practices Providing a Broader Range of Services Have Lower Medicare Expenditures and Emergency Department Utilization

“…Variations in two other claim-based measures of primary care comprehensiveness, New Problem Management (NPM) and Involvement in Patient Conditions (IPC), are not associated with Practice-ROS. IPC measures the degree to which the individual PCP [6], or PCPs at the practice [7], is involved in the broad range of conditions for which their patients receive care, while NPM measures the extent to which the PCPs effectively address the various common new problems their patients present to them [5,6,7]. Therefore, as intended, these three distinct measures (Practice-ROS, IPC, and NPM) capture different aspects of primary care comprehensiveness [5,6].…”

“…These include the depth and breadth of conditions managed by the primary care practitioner (PCP), as well as the extent to which the PCP can effectively address the many relatively common problems their patients may experience [5,6]. Recently, Medicare claims have been used to develop reliable and valid measures of these two dimensions of primary care comprehensiveness [6,7].…”

Medicare beneficiaries with more comprehensive primary care physicians report better primary care

“…For each measure, we calculated a physician-specific score using the Medicare FFS claims for all beneficiaries the physician treated in 2017. Details on each measure have been published 6,9 and are in the Appendix S1. Briefly, the involvement in patient conditions measure defines comprehensive physicians as those involved in caring for the broad range of their patients' health conditions reflected in visit-related International Classification of Disease (ICD-10) codes in a calendar year.…”

“…CPC+ data include claims, a survey of Medicare fee‐for‐service (FFS) beneficiaries, and information on a wide range of beneficiary, physician, practice, and market characteristics. In addition, despite the demonstrated benefits of PCP comprehensiveness to Medicare beneficiaries' care, 6–9 it is unclear whether beneficiaries will value their PCPs providing more comprehensive care. Patients often equate access to more care with higher‐quality care, 22 and recent evidence suggests that Medicare FFS beneficiaries' appetite for accessing specialized care has increased over time 23,24 .…”

“…1,[6][7][8] Without a comprehensive PCP, patients experience fragmented care from different specialists, resulting in higher health care costs, more diagnostic tests and interventions, and more medications. 1,[9][10][11] PCP and practice comprehensiveness are associated with reductions in patient hospitalizations, ED visits, total expenditures, [6][7][8][9][10][11][12] and duplicative service use-and with improvements in overall health and equity. [13][14][15] Less is known about whether PCP comprehensiveness is associated with patient-reported outcomes, specifically, patients' overall rating of care from their PCP and practice staff.…”