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Bell N, Lòpez-De Fede A, Cai B, Brooks J. Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures. PLoS One 2022; 17:e0273805. [PMID: 36067180 PMCID: PMC9447909 DOI: 10.1371/journal.pone.0273805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Previous studies have found a mixed association between Patient-Centered Medical Home (PCMH) designation and improvements in primary care quality indicators, including avoidable pediatric emergency department (ED) encounters. Whether these associations persist after accounting for the geographic locations of providers relative to where patients reside is unknown. OBJECTIVE To examine the association between geographic proximity to primary care providers versus hospitals and risk of avoidable and potentially avoidable ED visits among children with pre-existing diagnosis of attention-deficit/hyperactivity disorder or asthma. METHODS Retrospective cohort study of a panel of pediatric Medicaid claims data from the South Carolina from 2016-2018 for 2,959 beneficiaries having a pre-existing diagnosis of attention-deficit/hyperactivity disorder (ADD, ages 6-12) and 6,390 beneficiaries with asthma (MMA, ages 5-18), as defined using Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. We calculated differences in avoidable and potentially avoidable ED visits by the beneficiary's PCMH attribution type and in relation to differences in proximity to their primary care providers versus hospitals. Outcomes were defined using the New York University Emergency Department Algorithm (NYU-EDA). Differences in ED visit risk were assessed using generalized estimation equations and compared using marginal effects models. RESULTS The 2.4 percentage point reduction in risk of avoidable ED visits among children in the ADD cohort who attended a PCMH versus those who did not increased to 3.9 to 7.2 percentage points as relative proximity to primary care providers versus hospitals improved (p < 0.01). Children in the ADD and MMA cohorts that were enrolled in a medical home, but did not attend one for primary care services exhibited a 5.4 and 3.0 percentage point increase in avoidable ED visit compared to children who were unenrolled and did not attend medical homes (p < 0.05), but these differences were only observed when geographic proximity to hospitals was more convenient than primary care providers. Mixed findings were observed for potentially avoidable visits. CONCLUSIONS In several health care performance evaluations, patient-centered medical homes have not been found to reduce differences in hospital utilization for conditions that are treatable in primary care settings among children with chronic illnesses. Analytical approaches that also consider geographic proximity to health care services can identify performance benefits of medical homes. Expanding risk-adjustment models to also include geographic data would benefit ongoing quality improvement initiatives.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, Columbia, South Carolina, United States of America
| | - Bo Cai
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - John Brooks
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
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Miksanek TJ, Edwards ST, Weyer G, Laiteerapong N. Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits. JAMA Netw Open 2022; 5:e2229504. [PMID: 36044213 PMCID: PMC9434360 DOI: 10.1001/jamanetworkopen.2022.29504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with time-based billing. OBJECTIVE To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used 2019 billing data for outpatient E/M codes and 2021 reimbursement rates from the Centers for Medicare & Medicaid Services. Modeling of generic clinic templates was performed to estimate expected yearly E/M revenues for a single full-time physician working in an outpatient clinic using fee-for-service billing. MAIN OUTCOMES AND MEASURES Yearly E/M revenues for different patient visit templates were modeled. The standardized length of return patient visits was 10 to 45 minutes, and new patient visits were twice as long in duration. RESULTS Under MDM-based billing, increased visit length was associated with decreased E/M revenue ($564 188 for 30-minute new patient visit/15-minute return patient visit vs $423 137 for 40-minute new patient visit/20-minute return patient visit). Under time-based billing, yearly E/M revenue remained similar across increasing visit lengths ($400 432 for 30-minute new patient visit/15-minute return patient visit vs $458 718 for 40-minute new patient visit/20-minute return patient visit). Compared with time-based billing, MDM-based billing was associated with higher E/M revenue for 10- to 15-minute return patient visits ($400 432 vs $564 188). Time-based billing was associated with higher E/M revenue for return patient visits lasting 20 minutes or longer. The highest modeled E/M revenue of $846 273 occurred for 10-minute return patient visits under MDM-based billing. CONCLUSIONS AND RELEVANCE Results of this study showed that the relative economic benefits of MDM-based billing and time-based billing differed and were associated with the length of patient visits. Physicians with longer patient visits were more likely to experience revenue increases from using time-based billing than physicians with shorter patient visits.
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Affiliation(s)
- Tyler J. Miksanek
- Biological Sciences Division, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Samuel T. Edwards
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
- Section of General Internal Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - George Weyer
- Biological Sciences Division, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Neda Laiteerapong
- Biological Sciences Division, Department of Medicine, University of Chicago, Chicago, Illinois
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Tou LC, Jeyakumar SJ, Siddiqui TA, Ravi S, Prakash N. Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study. J Patient Exp 2022; 9:23743735221117359. [PMID: 35936512 PMCID: PMC9350501 DOI: 10.1177/23743735221117359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Direct primary care (DPC) is a growing model of care that is suggested as an
alternative to traditional fee-for-service healthcare. Patient-reported
experiences of DPC can provide unique insight into the impact of joining the
model and inform quality improvement. The purpose of this study was to
investigate patient perceptions of DPC. Thirty-one participants were initially
recruited for the study and completed a survey assessing patient demographics.
Of the 31 participants, 10 went on to complete the focus group interviews.
Qualitative analysis of focus group transcripts identified common themes and
subthemes. Focus group findings were stratified into 4 themes including quality
of care, access to care, affordability, physician qualities, and reasons for
choosing DPC. The top positive subthemes were good communication, joining DPC
due to poor past healthcare experiences, and physician personability. The most
common negative subthemes were difficulty referring to specialists outside the
practice, poor communication, and poor access to medications. All findings were
presented and discussed with the investigated clinic to facilitate improvements
in healthcare delivery.
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Affiliation(s)
- Leila C. Tou
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Shereen J. Jeyakumar
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | | | - Srekar Ravi
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
| | - Nirmala Prakash
- Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL, USA
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Patient-Centered Medical Homes and Pediatric Preventive Counseling. Acad Pediatr 2021; 21:488-496. [PMID: 32650049 DOI: 10.1016/j.acap.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities. METHODS We analyzed 4814 children and adolescents ages 0 to 17 who visited their usual sources of care in the nationally representative Medical Expenditure Panel Survey Medical Organizations Survey (MEPS-MOS), a household survey combined with a survey of household members' usual sources of care. We identified PCMHs using lists from certifying or accrediting organizations. For other practices in the MEPS-MOS, 2 quality-related activities were 1) reports to physicians about their clinical quality of care, and 2) electronic health record system reminders to physicians. Regressions controlled for practice, child, and family characteristics. RESULTS Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy. CONCLUSIONS PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.
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Jia L, Meng Q, Scott A, Yuan B, Zhang L. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database Syst Rev 2021; 1:CD011865. [PMID: 33469932 PMCID: PMC8094987 DOI: 10.1002/14651858.cd011865.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Changes to the method of payment for healthcare providers, including pay-for-performance schemes, are increasingly being used by governments, health insurers, and employers to help align financial incentives with health system goals. In this review we focused on changes to the method and level of payment for all types of healthcare providers in outpatient healthcare settings. Outpatient healthcare settings, broadly defined as 'out of hospital' care including primary care, are important for health systems in reducing the use of more expensive hospital services. OBJECTIVES To assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase (searched 5 March 2019), and several other databases. In addition, we searched clinical trials platforms, grey literature, screened reference lists of included studies, did a cited reference search for included studies, and contacted study authors to identify additional studies. We screened records from an updated search in August 2020, with any potentially relevant studies categorised as awaiting classification. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for healthcare providers working in outpatient care settings. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We conducted a structured synthesis. We first categorised the payment methods comparisons and outcomes, and then described the effects of different types of payment methods on different outcome categories. Where feasible, we used meta-analysis to synthesise the effects of payment interventions under the same category. Where it was not possible to perform meta-analysis, we have reported means/medians and full ranges of the available point estimates. We have reported the risk ratio (RR) for dichotomous outcomes and the relative difference (as per cent change or mean difference (MD)) for continuous outcomes. MAIN RESULTS We included 27 studies in the review: 12 randomised trials, 13 controlled before-and-after studies, one interrupted time series, and one repeated measure study. Most healthcare providers were primary care physicians. Most of the payment methods were implemented by health insurance schemes in high-income countries, with only one study from a low- or middle-income country. The included studies were categorised into four groups based on comparisons of different payment methods. (1) Pay for performance (P4P) plus existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings P4P incentives probably improve child immunisation status (RR 1.27, 95% confidence interval (CI) 1.19 to 1.36; 3760 patients; moderate-certainty evidence) and may slightly increase the number of patients who are asked more detailed questions on their disease by their pharmacist (MD 1.24, 95% CI 0.93 to 1.54; 454 patients; low-certainty evidence). P4P may slightly improve primary care physicians' prescribing of guideline-recommended antihypertensive medicines compared with an existing payment method (RR 1.07, 95% CI 1.02 to 1.12; 362 patients; low-certainty evidence). We are uncertain about the effects of extra P4P incentives on mean blood pressure reduction for patients and costs for providing services compared with an existing payment method (very low-certainty evidence). Outcomes related to workload or other health professional outcomes were not reported in the included studies. One randomised trial found that compared to the control group, the performance of incentivised professionals was not sustained after the P4P intervention had ended. (2) Fee for service (FFS) compared with existing payment methods for healthcare providers working in outpatient healthcare settings We are uncertain about the effect of FFS on the quantity of health services delivered (outpatient visits and hospitalisations), patient health outcomes, and total drugs cost compared to an existing payment method due to very low-certainty evidence. The quality of service provision and health professional outcomes were not reported in the included studies. One randomised trial reported that physicians paid via FFS may see more well patients than salaried physicians (low-certainty evidence), possibly implying that more unnecessary services were delivered through FFS. (3) FFS mixed with existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings FFS mixed payment method may increase the quantity of health services provided compared with an existing payment method (RR 1.37, 95% CI 1.07 to 1.76; low-certainty evidence). We are uncertain about the effect of FFS mixed payment on quality of services provided, patient health outcomes, and health professional outcomes compared with an existing payment method due to very low-certainty evidence. Cost outcomes and adverse effects were not reported in the included studies. (4) Enhanced FFS compared with FFS for healthcare providers working in outpatient healthcare settings Enhanced FFS (higher FFS payment) probably increases child immunisation rates (RR 1.25, 95% CI 1.06 to 1.48; moderate-certainty evidence). We are uncertain whether higher FFS payment results in more primary care visits and about the effect of enhanced FFS on the net expenditure per year on covered children with regular FFS (very low-certainty evidence). Quality of service provision, patient outcomes, health professional outcomes, and adverse effects were not reported in the included studies. AUTHORS' CONCLUSIONS For healthcare providers working in outpatient healthcare settings, P4P or an increase in FFS payment level probably increases the quantity of health service provision (moderate-certainty evidence), and P4P may slightly improve the quality of service provision for targeted conditions (low-certainty evidence). The effects of changes in payment methods on health outcomes is uncertain due to very low-certainty evidence. Information to explore the influence of specific payment method design features, such as the size of incentives and type of performance measures, was insufficient. Furthermore, due to limited and very low-certainty evidence, it is uncertain if changing payment models without including additional funding for professionals would have similar effects. There is a need for further well-conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low- and middle-income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions.
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Affiliation(s)
- Liying Jia
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab for Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qingyue Meng
- China Center for Health Development Studies (CCHDS), Peking University, Beijing, China
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Carlton, Melbourne, Australia
| | - Beibei Yuan
- China Center for Health Development Studies (CCHDS), Peking University, Beijing, China
| | - Lu Zhang
- Weihai Health Care Security Administration, Weihai, China
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Community social determinants and health outcomes drive availability of patient-centered medical homes. Health Place 2020; 67:102439. [PMID: 33212394 DOI: 10.1016/j.healthplace.2020.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
The collaborative design of America's patient-centered medical homes places these practices at the forefront of emerging efforts to address longstanding inequities in the quality of primary care experienced among socially and economically marginalized populations. We assessed the geographic distribution of the country's medical homes and assessed whether they are appearing within communities that face greater burdens of disease and social vulnerability. We assessed overlapping spatial clusters of mental and physical health surveys; health behaviors, including alcohol-impaired driving deaths and drug overdose deaths; as well as premature mortality with clusters of medical home saturation and community socioeconomic characteristics. Overlapping spatial clusters were assessed using odds ratios and marginal effects models, producing four different scenarios of resource need and resource availability. All analyses were conducted using county-level data for the contiguous US states. Counties having lower uninsured rates and lower poverty rates were the most consistent indicators of medical home availability. Overall, the analyses indicated that medical homes are more likely to emerge within communities that have more favorable health and socioeconomic conditions to begin with. These findings suggest that intersecting the spatial footprints of medical homes in relation to health and socioeconomic data can provide crucial information for policy makers and payers invested in narrowing the gaps between clinic availability and the communities that experience the brunt of health and social inequalities.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, United States
| | - Rebecca Wilkerson
- Institute for Families in Society, University of South Carolina, United States
| | | | - Ana Lòpez-De Fede
- Institute for Families in Society, University of South Carolina, United States.
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Bell N, Wilkerson R, Mayfield-Smith K, Lòpez-De Fede A. Association of Patient-Centered Medical Home designation and quality indicators within HRSA-funded community health center delivery sites. BMC Health Serv Res 2020; 20:980. [PMID: 33109162 PMCID: PMC7588949 DOI: 10.1186/s12913-020-05826-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Patient-Centered Medical Home (PCMH) adoption is an important strategy to help improve primary care quality within Health Resources and Service Administration (HRSA) community health centers (CHC), but evidence of its effect thus far remains mixed. A limitation of previous evaluations has been the inability to account for the proportion of CHC delivery sites that are designated medical homes. Methods Retrospective cross-sectional study using HRSA Uniform Data System (UDS) and certification files from the National Committee for Quality Assurance (NCQA) and the Joint Commission (JC). Datasets were linked through geocoding and an approximate string-matching algorithm. Predicted probability scores were regressed onto 11 clinical performance measures using 10% increments in site-level designation using beta logistic regression. Results The geocoding and approximate string-matching algorithm identified 2615 of the 6851 (41.8%) delivery sites included in the analyses as having been designated through the NCQA and/or JC. In total, 74.7% (n = 777) of the 1039 CHCs that met the inclusion criteria for the analysis managed at least one NCQA- and/or JC-designated site. A proportional increase in site-level designation showed a positive association with adherence scores for the majority of all indicators, but primarily among CHCs that designated at least 50% of its delivery sites. Once this threshold was achieved, there was a stepwise percentage point increase in adherence scores, ranging from 1.9 to 11.8% improvement, depending on the measure. Conclusion Geocoding and approximate string-matching techniques offer a more reliable and nuanced approach for monitoring the association between site-level PCMH designation and clinical performance within HRSA’s CHC delivery sites. Our findings suggest that transformation does in fact matter, but that it may not appear until half of the delivery sites become designated. There also appears to be a continued stepwise increase in adherence scores once this threshold is achieved.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, USA
| | - Rebecca Wilkerson
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, Columbia, USA
| | - Kathy Mayfield-Smith
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, Columbia, USA
| | - Ana Lòpez-De Fede
- Division of Integrated Health and Policy Research, Institute for Families in Society, University of South Carolina, 1600 Hampton St., Suite 507, Columbia, SC, 29208, USA.
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Saluja S, Hochman M, Bourgoin A, Maxwell J. Primary Care: the New Frontier for Reducing Readmissions. J Gen Intern Med 2019; 34:2894-2897. [PMID: 31621049 PMCID: PMC6854170 DOI: 10.1007/s11606-019-05428-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
To date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, we examined the literature focusing on primary care-based efforts to reduce readmissions. While rigorous studies on interventions arising from primary care are limited, we found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most promising. However, policy changes are necessary to spur innovation and support effective primary care-led transitions interventions. Though more rigorous research is needed, our findings suggest that primary care can and should lead future efforts for reducing hospital readmissions.
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Affiliation(s)
- Sonali Saluja
- The Gehr Family Center for Health Systems Science & Innovation, Keck Medicine of USC, 2020 Zonal Avenue, 323 IRD, Los Angeles, CA, 90033, USA.
| | - Michael Hochman
- The Gehr Family Center for Health Systems Science & Innovation, Keck Medicine of USC, 2020 Zonal Avenue, 323 IRD, Los Angeles, CA, 90033, USA
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Dilger BT, Gill MC, Lenhart JG, Garrison GM. Visit Entropy Associated with Diabetic Control Outcomes. J Am Board Fam Med 2019; 32:739-745. [PMID: 31506370 PMCID: PMC10725661 DOI: 10.3122/jabfm.2019.05.190026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Chronic diseases such as type 2 diabetes place a large burden on the health care system and are associated with increased morbidity and mortality. A team-based multidisciplinary approach that organizes care to improve chronic disease management may actually decrease traditional continuity of care metrics. Visit entropy (VE) provides a novel measure of care organization produced by team-based approaches. Higher VE, reflecting more disorganized care, has been associated with more hospital readmissions. We hypothesized that higher VE was also associated with reduced adherence to the D5 quality criteria. METHODS A retrospective study of 6590 adult diabetic patients in 5 established medical home practices was conducted. Multivariate logistic regression was used to determine if VE was associated with the dependent variable of D5 control. Separate models for usual provider continuity, continuity of care index, and sequence continuity were also constructed. RESULTS Less organized care with a higher VE was associated with decreased odds of D5 control (odds ratio = 0.88; 95% confidence interval, 0.80 to 0.97). The other continuity measures were not significant. Age, education level, and initial HgA1c were significant covariates, but sex, race, endocrine consults, and Charlson comorbidity were not significant. The Number Needed to be Exposed to more organized care to produce 1 more controlled diabetic was 32.5. CONCLUSIONS More organized care reflected by a lower VE is associated with improved odds of D5 diabetic control. VE represents a better measure of care organization in team-based medical home environments than traditional continuity of care metrics.
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Affiliation(s)
- Benjamin T Dilger
- From Department of Family Medicine, Mayo Clinic, Rochester, MN 55905 (BTD, MCG, GMG); Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 55703 (JGL)
| | - Margaret C Gill
- From Department of Family Medicine, Mayo Clinic, Rochester, MN 55905 (BTD, MCG, GMG); Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 55703 (JGL)
| | - Jill G Lenhart
- From Department of Family Medicine, Mayo Clinic, Rochester, MN 55905 (BTD, MCG, GMG); Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 55703 (JGL)
| | - Gregory M Garrison
- From Department of Family Medicine, Mayo Clinic, Rochester, MN 55905 (BTD, MCG, GMG); Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 55703 (JGL).
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Alcusky M, Singer D, Keith SW, Hegarty SE, Lombardi M, Saccenti E, Maio V. Evaluation of Care Processes and Health Care Utilization in Newly Implemented Medical Homes in Italy: A Population-Based Cross-sectional Study. Am J Med Qual 2019; 35:265-273. [PMID: 31271037 DOI: 10.1177/1062860619860590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the Local Health Authority (LHA) of Parma, Emilia Romagna, Italy, 16 medical homes were established between 2011 and 2014. The authors implemented a 1-year (January 1, 2015, to December 31, 2015) cross-sectional population-based design to compare utilization and processes of care between medical homes and comparison practices using the Parma LHA administrative health care database. Residents (n = 372 396) attributed to a primary care physician practicing in a medical home as of January 1, 2015, were considered exposed to medical homes. Adjusted rates of emergency department (ED) use (incidence rate ratio [IRR] = 0.86; 95% CI = 0.82-0.90), potentially avoidable ED use (IRR = 0.78; 95% CI = 0.72-0.84), and hospitalization for chronic ambulatory care sensitive conditions (ACSCs; IRR = 0.87, 95% CI = 0.78-0.97) were lower among patients in medical homes. Performance on process of care measures favored the medical home group; however, associations were generally weak. Receipt of care in medical homes in Parma LHA was associated with lower rates of avoidable ED visits and hospitalizations for chronic ACSCs.
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11
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Offsetting Patient-Centered Medical Homes Investment Costs Through Per-Member-Per-Month or Medicare Merit-based Incentive Payment System Incentive Payments. J Ambul Care Manage 2019; 41:105-113. [PMID: 29298177 DOI: 10.1097/jac.0000000000000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary care practices become patient-centered medical homes (PCMHs) to improve care. However, investment costs and opportunities to offset those costs are critical to the decision. We examined potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS) for a network that spent $4 818 260 over 4 years obtaining and renewing PCMH recognition for 57 practices. With PMPM payments of $3.37 to $8.98, "breakeven" requires that 2.4% to 6.4% of the network's 1645 commercially insured patients per physician be covered, while applying MIPS incentive payments of half the maximum available each year to the network's average 2016 Medicare reimbursement of $196 812 per physician showed they would exceed PCMH costs by 2022.
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Martsolf GR, Kandrack R, Friedberg MW, Briscombe B, Hussey PS, LaBonte C. Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review. Health Serv Res Manag Epidemiol 2019; 6:2333392819842484. [PMID: 31069248 PMCID: PMC6492354 DOI: 10.1177/2333392819842484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 11/15/2022] Open
Abstract
The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices' adoption of "comprehensive primary care" capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.
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Affiliation(s)
- Grant R Martsolf
- RAND Corporation, Pittsburgh, PA, USA.,Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan Kandrack
- RAND Corporation, Pittsburgh, PA, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark W Friedberg
- RAND Corporation, Boston, MA, USA.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Miller WL, Rubinstein EB, Howard J, Crabtree BF. Shifting Implementation Science Theory to Empower Primary Care Practices. Ann Fam Med 2019; 17:250-256. [PMID: 31085529 PMCID: PMC6827625 DOI: 10.1370/afm.2353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/12/2018] [Accepted: 12/18/2018] [Indexed: 11/09/2022] Open
Abstract
Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need external support to meet these demands. After a decade of initiatives, many stakeholders now question the return on their investments. Overall improvements in quality metrics, utilization cost savings, and patient experience have been less than anticipated. While recently conducting a research project in primary care practices, we unexpectedly discovered 3 practices that profoundly shifted our thinking about the sources and directionality of practice change and the underlying assumptions of D&I. Inspired by these practices-along with systems thinking, complexity theory, action research, and the collaborative approaches of community-based participatory research-we propose a reimagining of D&I theory to empower practices. We shift the emphasis regarding the source and direction of change from outside-in to inside-out Such a shift has the potential to open a new frontier in the science of dissemination and implementation and inform better health policy.
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Affiliation(s)
- William L Miller
- Lehigh Valley Health Network/University of South Florida Morsani College of Medicine, Allentown, Pennsylvania
| | - Ellen B Rubinstein
- Department of Sociology & Anthropology, North Dakota State Universiry, Fargo, North Dakota
| | - Jenna Howard
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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14
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Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals. Health Care Manage Rev 2019. [PMID: 29533271 DOI: 10.1097/hmr.0000000000000194] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels. PURPOSE The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff). METHODS/APPROACH We conducted semistructured interviews with 24 health care administrators, physician and nonphysician primary care providers, and administrative staff representing 10 primary care practices affiliated with one integrated delivery system. RESULTS Participants across all roles identified similar organizational- and team-level factors that influence QI implementation including organizational capacity to take on new initiatives (e.g., time availability of physicians), technical capability for QI (e.g., data analysis skills), and team climate (e.g., how well staff work together). There was greater variation in terms of individual-level factors, particularly perceived meaning and purpose of QI. Perceptions about value of QI ranged from positive impacts on patient care and practice competitiveness to decreased efficiency and distractions from patient care, but differences did not appear attributable to role. CONCLUSIONS Successful QI implementation requires effective collaboration within cross-functional teams. Additional research is needed to assess how best to employ implementation strategies that promote cross-understanding of QI among team members and, ultimately, effective implementation of QI programs. PRACTICE IMPLICATIONS Health care managers in primary care settings should strive to create a strong teamwork climate, reinforced by opportunities for staff in various roles to discuss QI as a collective.
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15
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Strengthening primary care locally and globally: An interview with Asaf Bitton from Ariadne Labs. Healthcare (Basel) 2018; 6:240-241. [DOI: 10.1016/j.hjdsi.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022] Open
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16
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Sinaiko AD, Landrum MB, Meyers DJ, Alidina S, Maeng DD, Friedberg MW, Kern LM, Edwards AM, Flieger SP, Houck PR, Peele P, Reid RJ, McGraves-Lloyd K, Finison K, Rosenthal MB. Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief. Health Aff (Millwood) 2018; 36:500-508. [PMID: 28264952 DOI: 10.1377/hlthaff.2016.1235] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures. The initiatives were associated with a 1.5 percent reduction in the use of specialty visits and a 1.2 percent increase in cervical cancer screening among all patients, and a 4.2 percent reduction in total spending (excluding pharmacy spending) and a 1.4 percent increase in breast cancer screening among higher-morbidity patients. These associations were significant. Identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.
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Affiliation(s)
- Anna D Sinaiko
- Anna D. Sinaiko is a research scientist in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Mary Beth Landrum
- Mary Beth Landrum is a professor of biostatistics in the Department of Health Care Policy at Harvard Medical School, in Boston
| | - David J Meyers
- David J. Meyers is a doctoral student in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island
| | - Shehnaz Alidina
- Shehnaz Alidina is a research associate in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
| | - Daniel D Maeng
- Daniel D. Maeng is a research investigator at the Center for Health Research in the Geisinger Health System, in Danville, Pennsylvania
| | - Mark W Friedberg
- Mark W. Friedberg is a senior natural scientist and director at the RAND Corporation in Boston
| | - Lisa M Kern
- Lisa M. Kern is an associate professor of health care policy and research at Weill Cornell Medical College, in New York City
| | - Alison M Edwards
- Alison M. Edwards is a senior research biostatistician at Weill Cornell Medical College
| | - Signe Peterson Flieger
- Signe Peterson Flieger is an assistant professor of public health and community medicine at the Tufts University School of Medicine, in Boston
| | - Patricia R Houck
- Patricia R. Houck is a statistician at UPMC Health Plan, in Pittsburgh, Pennsylvania
| | - Pamela Peele
- Pamela Peele is vice president of health economics at UPMC Health Plan
| | - Robert J Reid
- Robert J. Reid is an affiliate investigator, Group Health Research Institute, in Seattle, Washington
| | - Katharine McGraves-Lloyd
- Katharine McGraves-Lloyd is a senior business information analyst at Anthem Inc., in Washington, D.C
| | - Karl Finison
- Karl Finison is director of analytic development at Onpoint Health Data, in Portland, Maine
| | - Meredith B Rosenthal
- Meredith B. Rosenthal is a professor of health economics and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health
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17
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Bitton A. Finding a Parsimonious Path for Primary Care Practice Transformation. Ann Fam Med 2018; 16:S16-S19. [PMID: 29632221 PMCID: PMC5891309 DOI: 10.1370/afm.2234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts Center for Primary Care, Harvard Medical School, Boston, Massachusetts
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18
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Basu S, Phillips RS, Song Z, Bitton A, Landon BE. High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care. Health Aff (Millwood) 2017; 36:1599-1605. [DOI: 10.1377/hlthaff.2017.0367] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sanjay Basu
- Sanjay Basu ( ) is an assistant professor of medicine, Department of Medicine, Stanford University School of Medicine, in California
| | - Russell S. Phillips
- Russell S. Phillips is director of the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts
| | - Zirui Song
- Zirui Song is an assistant professor of health care policy, Department of Health Care Policy, Harvard Medical School
| | - Asaf Bitton
- Asaf Bitton is an assistant professor of medicine, Division of General Medicine, Brigham and Women’s Hospital, in Boston
| | - Bruce E. Landon
- Bruce E. Landon is a professor in the Department of Health Care Policy, Harvard Medical School
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Fleming NS, da Graca B, Ogola GO, Culler SD, Austin J, McConnell P, McCorkle R, Aponte P, Massey M, Fullerton C. Costs of Transforming Established Primary Care Practices to Patient-Centered Medical Homes (PCMHs). J Am Board Fam Med 2017; 30:460-471. [PMID: 28720627 PMCID: PMC5939952 DOI: 10.3122/jabfm.2017.04.170039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs. METHODS We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases. We then developed and sent a survey to all primary care practices (practice-level response rate: initial recognition-44.6%, renewal-35.7%). Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures. RESULTS We estimated HealthTexas' corporate costs for initial NCQA recognition (2010-2012) at $1,508,503; for renewal (2014-2016), $346,617; the Care Coordination resource costs an additional ongoing $390,790/year. A hypothetical 5-physician HealthTexas practice spent another estimated 239.5 hours ($10,669) obtaining, and 110.5 hours ($4,957) renewing, recognition. CONCLUSION Centralized PCMH support reduces the burden on practices; however, overall time and cost remains substantial, and should be weighed against the mixed evidence regarding PCMH's impact on quality and costs of care.
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Affiliation(s)
- Neil S Fleming
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF).
| | - Briget da Graca
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Gerald O Ogola
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Steven D Culler
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Jessica Austin
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Patrice McConnell
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Russell McCorkle
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Phil Aponte
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Michael Massey
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
| | - Cliff Fullerton
- From the Center for Clinical Effectiveness (NSF, BdG, GOO) and STEEEP Analytics (JA), Office of the CQO, Baylor Scott & White Health, Dallas, TX; the Robbins Institute for Health Policy & Leadership, Baylor University, Waco (NSF, BdG); the Rollins School of Public Health, Emory University, Atlanta, GA (SDC); the HealthTexas Provider Network, Dallas (PM, RM, PA, MM); the Baylor Scott & White Quality Alliance, Dallas (MM, CF); and Baylor Scott & White Health, Dallas (CF)
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Physician Payment Methods and the Patient-Centered Medical Home. J Ambul Care Manage 2017; 40:114-120. [DOI: 10.1097/jac.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Magill MK. Time to Do the Right Thing: End Fee-for-Service for Primary Care. Ann Fam Med 2016; 14:400-1. [PMID: 27621155 PMCID: PMC5394371 DOI: 10.1370/afm.1977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael K Magill
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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