The Relationships of Physician Practice Characteristics to Quality of Care and Costs

Abstract

Background Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice‐level characteristics and the quality and cost of care. Methods Practice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims‐computable measures of screening and monitoring, avoidable utilization, risk‐adjusted per‐beneficiary per‐year (PBPY) costs, and the practice's net revenue. Results Several characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved screening and monitoring. Conclusions Practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization. However, these relationships are not the only pathways connecting practice characteristics to cost and those additional pathways contain substantial “noise” adding uncertainty to the estimated direct effects. Some of the attributes thought to be important characteristics of accountable care organizations and medical homes appear to be associated with lower quality and no improvement in cost.

Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices

“…Finally, no data were available on practitioner level characteristics, such the physician’s knowledge or attitudes. Given the observed variance at practice level, there is a need to explore other, unmeasured practice or practitioner characteristics [44, 47]. …”

Spending per Medicare Beneficiary Is Higher in Hospital‐Owned Small‐ and Medium‐Sized Physician Practices

“…; Carlin, Dowd, and Feldman ; Kralewski et al. ). Hospital‐owned practices and larger practices have more resources—capital, information technology, and leaders whose time can be dedicated to finding ways to improve quality—to systematically improve the care they provide (Casalino et al.…”

“…Given the rapid movement of physicians into hospital employment and into larger practices and the accelerating impact that key health reform policies are likely having on these two trends, it is important for researchers and policy makers to note that hospital-owned practices and larger practices (at least in the range up to 19 physicians) do not necessarily perform better, or even as well, as physician-owned practices and smaller practices (Landon et al 2008;Weeks et al 2010;McWilliams et al 2013;Carlin, Dowd, and Feldman 2014;Kralewski et al 2015). Hospitalowned practices and larger practices have more resources-capital, information technology, and leaders whose time can be dedicated to finding ways to improve quality-to systematically improve the care they provide (Casalino et al 2003(Casalino et al , 2013(Casalino et al , 2016Friedberg et al 2007).…”

Characteristics of a stratified random sample of New Zealand general practices

“…Practice characteristics including rurality and size influence access to health care, [1][2][3] the type and frequency of screening and testing, [4][5][6] chronic disease management 7 and hospital admission. [8][9][10][11] The size and location of practices may affect the quality and safety of health care in other ways.…”