Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions

Abstract

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 sizeand 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.

Prior hospital admission predicts thirty-day hospital readmission for heart failure patients

“…In a recent report, Casalino et al [15] found that smaller primary care-based practices had lower rates of potentially preventable hospital admissions compared to larger practices. Outpatient follow-up and physician practice size may have had an effect on the rate of readmission in our population, but our study was not designed to measure this effect.…”

Solo and Small Practices: A Vital, Diverse Part of Primary Care

“…15 Citing literature on ease of access, [16][17][18] the authors suggested that this association stems from 9 stronger relationships among physicians, patients, and staff, and improved continuity. 18 Despite these benefits, small practices are less likely to use care coordinators or participate in quality improvement collaboratives.…”

The Paradox of Size: How Small, Independent Practices Can Thrive in Value-Based Care

“…Meanwhile, recent evidence suggests that small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, 6 fewer preventable hospital admissions, 7 and lower readmission rates than larger, independent-and hospital-owned practices. 8 In an era of value-based care, the autonomy of small practices and the preservation of the traditional doctor-patient relationship helps provide important reassurance to the patient that the physician is acting in his or her best interests.…”