Medical Group Characteristics and the Cost and Quality of Care for Medicare Beneficiaries

被引:17
作者
Casalino, Lawrence P. [1 ]
Ramsay, Patricia [2 ]
Baker, Laurence C. [3 ,4 ]
Pesko, Michael F. [5 ]
Shortell, Stephen M. [2 ,6 ]
机构
[1] Weill Cornell Med Coll, Div Hlth Policy & Econ, Dept Healthcare Policy & Res, 402 E 67th St,Room LA 217, New York, NY 10065 USA
[2] Univ Calif Berkeley, Sch Publ Hlth, CHOIR, Berkeley, CA 94720 USA
[3] Dept Hlth Res & Policy, Stanford, CA USA
[4] Stanford Inst Econ Policy Res, Stanford, CA USA
[5] Georgia State Univ, Dept Econ, Andrew Young Sch Policy Studies, Atlanta, GA 30303 USA
[6] Univ Calif Berkeley, Haas Sch Business, Berkeley, CA 94720 USA
关键词
Medical groups; hospital employment of physicians; PREVENTABLE HOSPITAL ADMISSIONS; PHYSICIAN PRACTICES; HEALTH CENTERS; VERTICAL INTEGRATION; HOME PROCESSES; PRICES; SIZE; PERFORMANCE; COMPETITION; INSURERS;
D O I
10.1111/1475-6773.13010
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective Data Sources/Study Setting To estimate the relationship between outcomes of care and medical practices' structure and use of organized care improvement processes. We linked Medicare claims data to our national survey of physician practices (2012-2013). Fifty percent response rate; 1,040 responding practices; 31,888 physicians; 868,213 attributed Medicare beneficiaries. Study Design Principal Findings Cross-sectional observational analysis of the relationship between practice characteristics and total spending, readmissions, and ambulatory care-sensitive admissions (ACSAs), for all beneficiaries and five categories of beneficiary defined by predicted need for care. Practices with 100+ physicians and 50-99 physicians had, respectively, annual spending per high-need beneficiary that was $1,870 (12.5 percent) and $1,824 higher than practices with 1-2 physicians, and readmission rates 1.64 and 1.71 higher. ACSA rates did not vary significantly by practice size. Outcomes did not vary significantly by ownership or by practices' use of organized processes to improve care. Conclusions Large practices had higher spending and readmission rates than the smallest practices, especially for high-need beneficiaries. There were no significant performance differences between physician-owned and hospital-owned practices. Policy makers should consider the effects of specific policies on provider organization, pending further research to learn which types of practice provide better care.
引用
收藏
页码:4970 / 4996
页数:27
相关论文
共 50 条
[41]   Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics [J].
Henning-Smith, Carrie ;
Prasad, Shailendra ;
Casey, Michelle ;
Kozhimannil, Katy ;
Moscovice, Ira .
JOURNAL OF RURAL HEALTH, 2019, 35 (01) :58-67
[42]   Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care [J].
Shan, Linghan ;
Li, Ye ;
Ding, Ding ;
Wu, Qunhong ;
Liu, Chaojie ;
Jiao, Mingli ;
Hao, Yanhua ;
Han, Yuzhen ;
Gao, Lijun ;
Hao, Jiejing ;
Wang, Lan ;
Xu, Weilan ;
Ren, Jiaojiao .
PLOS ONE, 2016, 11 (10)
[43]   Diabetes Care Quality: Do Large Medical Groups Perform Better? [J].
Solberg, Leif, I ;
Carlin, Caroline S. ;
Peterson, Kevin A. ;
Eder, Milton .
AMERICAN JOURNAL OF MANAGED CARE, 2022, 28 (03) :101-107
[44]   Quality Care Assessment of Parkinson's Disease at a Tertiary Medical Center [J].
Baek, William S. ;
Swenseid, Shannda S. ;
Poon, Kwun-Yee T. .
INTERNATIONAL JOURNAL OF NEUROSCIENCE, 2013, 123 (04) :221-225
[45]   Patient characteristics correlated with quality indicator outcomes in diabetes care [J].
Shani, Michal ;
Nakar, Sasson ;
Lustman, Alex ;
Baievsky, Tuvia ;
Rosenberg, Reena ;
Vinker, Shlomo .
BRITISH JOURNAL OF GENERAL PRACTICE, 2010, 60 (578) :655-659
[46]   Delivery system characteristics and their association with quality and costs of care: Implications for accountable care organizations [J].
Chukmaitov, Askar ;
Harless, David W. ;
Bazzoli, Gloria J. ;
Carretta, Henry J. ;
Siangphoe, Umaporn .
HEALTH CARE MANAGEMENT REVIEW, 2015, 40 (02) :92-103
[47]   Comparison of administrative data and medical records to measure the quality of medical care provided to vulnerable older patients [J].
MacLean, CH ;
Louie, R ;
Shekelle, PG ;
Roth, CP ;
Saliba, D ;
Higashi, T ;
Adams, J ;
T Chang, J ;
Kamberg, CJ ;
Solomon, DH ;
Young, RT ;
Wenger, NS .
MEDICAL CARE, 2006, 44 (02) :141-148
[48]   Effects of Competition on the Cost and Quality of Inpatient Rehabilitation Care under Prospective Payment [J].
Colla, Carrie Hoverman ;
Escarce, Jose J. ;
Buntin, Melinda Beeuwkes ;
Sood, Neeraj .
HEALTH SERVICES RESEARCH, 2010, 45 (06) :1981-2006
[49]   Tree-based Claims Algorithm for Measuring Pretreatment Quality of Care in Medicare Disabled Hepatitis C Patients [J].
Chirikov, Viktor V. ;
Shaya, Fadia T. ;
Onukwugha, Ebere ;
Mullins, C. Daniel ;
dosReis, Susan ;
Howell, Charles D. .
MEDICAL CARE, 2017, 55 (12) :E104-E112
[50]   Digital Breast Tomosynthesis: Cost-Effectiveness of Using Private and Medicare Insurance in Community-Based Health Care Facilities [J].
Hunter, Sara A. ;
Morris, Colleen ;
Nelson, Karl ;
Snyder, Brandon J. ;
Poulton, Thomas B. .
AMERICAN JOURNAL OF ROENTGENOLOGY, 2017, 208 (05) :1171-1175