Characteristics and Disparities among Primary Care Practices in the United States

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



Despite new incentives for US primary care, concerns abound that patient-centered practice capabilities are lagging.


Describe the practice structure, patient-centered capabilities, and payment relationships of US primary care practices; identify disparities in practice capabilities.


Analysis of the 2015 Medical Organizations Survey (MOS), part of the nationally representative Medical Expenditure Panel Survey (MEPS).


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.


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]).


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.


primary care practice characteristics disparities in primary care 


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.


  1. 1.
    Boult C, Wieland GD. Comprehensive primary care for older patients with multiple chronic conditions. JAMA. 2010;304(17):1936. Scholar
  2. 2.
    Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111–26. Scholar
  3. 3.
    Bitton A, Ratcliffe HL, Veillard JH, et al. Primary health care as a foundation for strengthening health systems in low- and middle-income countries. J Gen Intern Med. 2017;32(5):566–71. Scholar
  4. 4.
    Pesec M, Ratcliffe HL, Karlage A, Hirschhorn LR, Gawande A, Bitton A. Primary health care that works: the Costa Rican experience. Health Aff. 2017;36(3):531–38. Scholar
  5. 5.
    O’Malley AS, Rich EC. Measuring comprehensiveness of primary care: challenges and opportunities. J Gen Intern Med. 2015;30 Suppl 3:568–75. Scholar
  6. 6.
    Gaynor M, Mostashari F, Ginsburg PB. Making health care markets work. JAMA. 2017;316(16):1711–13. Scholar
  7. 7.
    Kane CK, Emmons DW. New data on physician practice arrangements: private practice remains strong despite shifts toward hospital employment. Accessed June 22, 2017.
  8. 8.
    Cutler DM, Scott Morton F. Hospitals, market share, and consolidation. JAMA. 2013;310(18):1964. Scholar
  9. 9.
    Jha AK. How would the next president ensure competitiveness in the health care marketplace? JAMA. 2017;317(2):125–6. Scholar
  10. 10.
    Levine DM, Healey MJ, Wright A, Bates DW, Linder JA, Samal L. Changes in the quality of care during progress from stage 1 to stage 2 of meaningful use. J Am Med Inform Assoc. 2016;24(2):ocw127. Scholar
  11. 11.
    Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76. Accessed 29 Febr 2016.
  12. 12.
    Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815–25. Scholar
  13. 13.
    Salzberg CA, Bitton A, Lipsitz SR, et al. The impact of alternative payment in chronically Ill and older patients in the patient-centered medical home. Med Care. 2017;55(5):483–92. Scholar
  14. 14.
    Medical Expenditure Panel Survey Medical Provider Component. 2013 Annual Methodology Report. Rockville, MD; 2013. Accessed 18 March 2016.
  15. 15.
    Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality. JAMA. 2000;283(19):2579. Scholar
  16. 16.
    Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005;353(7):692–700. Scholar
  17. 17.
    Fisher ES, Wennberg JE. Health care quality, geographic variations, and the challenge of supply-sensitive care. Perspect Biol Med. 2003;46(1):69–79. Accessed June 22, 2017.CrossRefPubMedGoogle Scholar
  18. 18.
    Machlin S, Yu W, Zodet M. Medical expenditure panel survey computing standard errors for MEPS Estimates. Rockville, MD: Agency for Healthcare Research and Quality; 2005. Accessed 22 Jan 2016.
  19. 19.
    Cohen S, Machlin S. Nonresponse adjustment strategy in the household component of the 1996 Medical Expenditure Panel Survey. J Econ Soc Meas. 1998;25:15–33.Google Scholar
  20. 20.
    Zodet M, Chowdhury S, Machlin S, Cohen J. Linked designs of the MEPS medical provider and organization surveys. Accessed 16 Oct 2017.
  21. 21.
    Linder JA, Levine DM. Health care communication technology and improved access, continuity, and relationships. JAMA Intern Med. 2016;176(5):643. Scholar
  22. 22.
    Levine DM, Linder JA, Landon BE. The quality of outpatient care delivered to adults in the United States, 2002 to 2013. JAMA Intern Med. 2016;176(12):1778. Scholar
  23. 23.
    Levine DM, Linder JA. Retail clinics shine a harsh light on the failure of primary care access. J Gen Intern Med 2015.
  24. 24.
    Hing E, Kurtzman E, Lau DT, Taplin C, Bindman AB. Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013. Natl Heal Stat Reports Number. 2017;101. Accessed 14 March 2017.
  25. 25.
    Peckham C. Medscape Physician Compensation Report 2016; 2016.
  26. 26.
    Muhlestein DB, Smith NJ. Physician consolidation: rapid movement from small to large group practices, 2013-15. Health Aff (Millwood). 2016;35(9):1638–42. Scholar

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

Personalised recommendations