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Article Title

Impact of Physician Practice Style on Costs, Clinical Quality, Patient Experience, Physician Productivity, and Physician Time

Publication Date

8-10-2017

Keywords

primary care, quality of care, health care costs/resource use, patient experience/satisfaction

Abstract

Background: During acute care visits, some primary care physicians (PCPs) typically focus on the presenting problem (“the focused”); others typically address additional issues (“max-packers”). Processes and outcomes may vary between these distinct practice styles. Max-packers, by managing additional conditions or preventive services during an acute care visit, may reduce the number of future visits and encourage up-to-date screening but may require more visit or charting time or increase testing and referrals. The focused, on the other hand, are expected to better manage patient flow. This study compares resource use (“costs”), clinical quality, patient experience, physician productivity and physician time for focused and max-packing PCPs.

Methods: We used administrative electronic health record (EHR) data and Press-Ganey surveys of a large ambulatory group practice. Our study population included 302 PCPs in 2011–2013 (828 PCP-years). The outcome variables were costs (per-visit PCP evaluation and management [E&M], and per-episode and annual costs except for inpatient care), clinical quality metrics pertinent to primary care practice, patient experience (patient-reported satisfaction with the care provider and wait time), physician productivity (work RVUs and panel size), and physician EHR open time away from office. All outcome measures were risk-adjusted to account for patient mix in PCP panels. PCPs were classified into three tertiles based on the average number of “other conditions” (identified through diagnosis codes) addressed per acute care episode. We compared PCP-years in the top third (max-packer) and bottom third (the focused).

Results: Max-packing was associated with higher per-visit E&M costs, higher total per-episode costs, but lower annual total costs. Compared to the focused, max-packers had higher scores for clinical quality and overall patient satisfaction, generated more work RVUs per clinical full-time equivalent, but had more EHR open time away from office and their patients had longer wait times in clinics.

Conclusion: Physician typical practice styles impact multiple dimensions of care delivery. Organizations with potentially competing priorities (affordability, care quality, patient experience, productivity and efficiency) should consider organizational structures and physician incentives with balancing metrics and appropriate risk adjustments that encourage physician behavior achieving primary organizational goals.

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