The Role of Organizational Affiliations in Physician Patient-Sharing Relationships

Geissler, Kimberley H.; Lubin, Benjamin; Ericson, Keith M. Marzilli

doi:10.1177/1077558718769403

Cited by 15 publications

(12 citation statements)

References 41 publications

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“…clustering, centrality). 7 Geissler et al (2018) using all payer data from Massachusetts find that practice sites and medical groups, but not physician contracting networks, are important determinants of referrals.…”

Section: Introductionmentioning

confidence: 99%

Team Formation and Performance: Evidence from Healthcare Referral Networks

Agha¹,

Ericson²,

Geissler³

et al. 2018

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Annual Meeting, and the NBER. We are also grateful to Jean Roth and Mohan Ramanujan for assistance obtaining and managing the Medicare claims data. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

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Section: Introductionmentioning

confidence: 99%

Team Formation and Performance: Evidence from Healthcare Referral Networks

Agha¹,

Ericson²,

Geissler³

et al. 2018

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“…For example, new affiliations and alliances may bottleneck or disrupt existing referral decision-makings practices in the network if limitations are imposed on the physicians control over choice of specialist. [153][154][155] Second, this paper introduced the concept of specialists also taking on brokerage roles when they opt to redirect a referral to their specialist colleague. This has wider implications for healthcare studies attempting to measure the structure of networks and 'actual' strengths of relationships within these networks, suggesting that the interplay between crossreferrals and brokerage roles in initiating new connections deserves more attention.…”

Section: Discussionmentioning

confidence: 99%

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

Kierkegaard

Owen‐Smith

2021

BMJ Open

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ObjectiveMost scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.DesignQualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.SettingThis study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.ParticipantsPurposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.ResultsTwo primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.ConclusionThis study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.

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“…Using Medicare data from the early 1990s and examining shared‐patient relationships, Shea and colleagues (1999) find referrals are less common in rural areas, but that seeing both a usual care provider and at least one other physician was not less common in rural areas . Their definition of referrals is difficult to compare to this study as referrals may reflect shared‐patient patterns from cross‐practice coverage, long‐term co‐management of a condition by a specialist and a PCP, or true referrals …”

Section: Discussionmentioning

confidence: 99%

Differences in referral patterns for rural primary care physicians from 2005 to 2016

Geissler

2019

Health Services Research

Self Cite

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| INTRODUC TI ONReferrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. 1,2 Referrals have increased over time, potentially due to the increased complexity of medical care 1 ;research shows PCP referral rates are stable within physician over time, but have significant variation across physicians. 4-6 Referrals contribute to appropriate medical care 1,4 ; better understanding current determinants of referrals and appropriate use is important for improving care delivery, particularly in medically underserved rural areas. 7,8 Access to care and availability of specialists are concerns in rural areas due to distance to providers and the nonrural location of many specialists. 7-10 This results in decreased specialist visits and an increased reliance on PCPs in rural areas. 11The ideal PCP referral rate within and across conditions to optimize patient care to provide the highest quality at the lowest cost is unknown. Referrals may be both over-and under-used by PCPs 12 ; referrals may generate excess spending and increase care fragmentation, but specialists have been shown to be more likely to Abstract Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined.Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions:Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. K E Y W O R D S ambulatory care, physician practice patterns, referrals, rural S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Geissler KH. Differences in referral patterns for rural primary care physicians from 2005 to 2016.Health Serv Res. 2020;55:94-102. https ://doi.

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The Role of Organizational Affiliations in Physician Patient-Sharing Relationships

Cited by 15 publications

References 41 publications

Team Formation and Performance: Evidence from Healthcare Referral Networks

Team Formation and Performance: Evidence from Healthcare Referral Networks

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

Differences in referral patterns for rural primary care physicians from 2005 to 2016

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