Characteristics and Disparities among Primary Care Practices in the United States

  • David Michael Levine
  • Jeffrey A. Linder
  • Bruce E. Landon
Original Research

Abstract

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.

KEY WORDS

primary care practice characteristics disparities in primary care 

Notes

Author Contributions

David Levine had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: all authors.

Acquisition, analysis, or interpretation of data: all authors.

Drafting of the manuscript: Levine.

Critical revision of the manuscript for important intellectual content: all authors.

Statistical analysis: Levine.

Administrative, technical, or material support: Levine.

Study supervision: Landon, Linder.

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflict of interest.

Financial Support

Dr. Levine has received funding support from an Institutional National Research Service Award (T32HP10251), the Ryoichi Sasakawa Fellowship Fund, and Brigham and Women’s Hospital Division of General Internal Medicine and Primary Care.

The NIH had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.

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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • David Michael Levine
    • 1
    • 2
  • Jeffrey A. Linder
    • 3
  • Bruce E. Landon
    • 2
    • 4
    • 5
  1. 1.Division of General Internal Medicine and Primary Care Brigham HealthBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Division of General Internal Medicine and GeriatricsNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  5. 5.Division of General Medicine and Primary CareBeth Israel Deaconess Medical CenterBostonUSA

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