TY - JOUR
KW - disparities in primary care
KW - practice characteristics
KW - primary care
AU - D. M. Levine
AU - J. A. Linder
AU - B. E. Landon
A1 - 
AB - BACKGROUND: Despite new incentives for US primary care, concerns abound that patient-centered practice capabilities are lagging. OBJECTIVE: Describe the practice structure, patient-centered capabilities, and payment relationships of US primary care practices; identify disparities in practice capabilities. DESIGN: Analysis of the 2015 Medical Organizations Survey (MOS), part of the nationally representative Medical Expenditure Panel Survey (MEPS). SETTING: Practice-reported information from primary care practices of MEPS respondents who reported receiving primary care and made at least one visit in 2015 to that practice. PARTICIPANTS: Surveyed primary care practices (n = 4318; 77% response rate) providing primary care to 7161 individuals, representing 101,159,263 Americans. MAIN MEASURES: Practice structure (ownership and personnel); practice capabilities (certification as a patient-centered medical home [PCMH], electronic health record [EHR] use, and x-ray capability); and payment orientation (accountable care organization [ACO] and capitation). KEY RESULTS: Independently owned practices served 55% of patients, hospital-owned practices served 19%, and nonprofit/government/academic-owned served 20%. Solo practices served 25% of patients and practices with 2-10 physicians served 53% of patients. Forty-one percent of patients were served by practices certified as PCMHs. Practices with EHRs cared for 90% of patients and could exchange secure messages with 78% of patients. Practices with in-office x-ray capability cared for 34% of patients. Practices participating in ACOs and capitation served 44% and 46% of patients, respectively. Primary care patients in the South, compared to the rest of the country, had less access to nearly all practice capabilities, including patient care coordination (adjusted difference, 13% [95% CI, 8-18]) and secure EHR messaging (adjusted difference, 6% [95% CI, 1-10]). Uninsured patients were less likely to be served at a practice that used an EHR (adjusted difference, 9% [95% CI, 2-16]). CONCLUSIONS: Participants' primary care practices were mostly independently owned, nearly always used EHRs (albeit of varying capability), and frequently participated in innovative payment arrangements for a portion of their patients. Patient practices in the South had fewer capabilities than the rest of the country.
AD - Division of General Internal Medicine and Primary Care , Brigham Health, Boston, MA, USA. dmlevine@bwh.harvard.edu.; Harvard Medical School, Boston, MA, USA. dmlevine@bwh.harvard.edu.; Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Harvard Medical School, Boston, MA, USA.; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
BT - Journal of general internal medicine
C5 - Financing & Sustainability; HIT & Telehealth; Medical Home
CP - 4
CY - United States
DO - 10.1007/s11606-017-4239-z
IS - 4
JF - Journal of general internal medicine
M1 - Journal Article
N2 - BACKGROUND: Despite new incentives for US primary care, concerns abound that patient-centered practice capabilities are lagging. OBJECTIVE: Describe the practice structure, patient-centered capabilities, and payment relationships of US primary care practices; identify disparities in practice capabilities. DESIGN: Analysis of the 2015 Medical Organizations Survey (MOS), part of the nationally representative Medical Expenditure Panel Survey (MEPS). SETTING: Practice-reported information from primary care practices of MEPS respondents who reported receiving primary care and made at least one visit in 2015 to that practice. PARTICIPANTS: Surveyed primary care practices (n = 4318; 77% response rate) providing primary care to 7161 individuals, representing 101,159,263 Americans. MAIN MEASURES: Practice structure (ownership and personnel); practice capabilities (certification as a patient-centered medical home [PCMH], electronic health record [EHR] use, and x-ray capability); and payment orientation (accountable care organization [ACO] and capitation). KEY RESULTS: Independently owned practices served 55% of patients, hospital-owned practices served 19%, and nonprofit/government/academic-owned served 20%. Solo practices served 25% of patients and practices with 2-10 physicians served 53% of patients. Forty-one percent of patients were served by practices certified as PCMHs. Practices with EHRs cared for 90% of patients and could exchange secure messages with 78% of patients. Practices with in-office x-ray capability cared for 34% of patients. Practices participating in ACOs and capitation served 44% and 46% of patients, respectively. Primary care patients in the South, compared to the rest of the country, had less access to nearly all practice capabilities, including patient care coordination (adjusted difference, 13% [95% CI, 8-18]) and secure EHR messaging (adjusted difference, 6% [95% CI, 1-10]). Uninsured patients were less likely to be served at a practice that used an EHR (adjusted difference, 9% [95% CI, 2-16]). CONCLUSIONS: Participants' primary care practices were mostly independently owned, nearly always used EHRs (albeit of varying capability), and frequently participated in innovative payment arrangements for a portion of their patients. Patient practices in the South had fewer capabilities than the rest of the country.
PP - United States
PY - 2018
SN - 1525-1497; 0884-8734
SP - 481
EP - 486
EP - 
T1 - Characteristics and Disparities among Primary Care Practices in the United States
T2 - Journal of general internal medicine
TI - Characteristics and Disparities among Primary Care Practices in the United States
U1 - Financing & Sustainability; HIT & Telehealth; Medical Home
U2 - 29204975
U3 - 10.1007/s11606-017-4239-z
VL - 33
VO - 1525-1497; 0884-8734
Y1 - 2018
Y2 - Apr
ER -