For each group participating, we conducted a 45- to 60-minute telephone interview with the president or chief executive officer, medical director, and nonphysician quality improvement leader. Physicians face a rapidly changing world of value-based payment,1 public reporting of physician performance,2 electronic health records (EHRs), patient-centered medical homes,3 and accountable care organizations (ACOs).4,5 Success is likely to require substantial investments in health information technology and skilled leadership and staff.6,7 Large organizations have the scale to make these investments while negotiating higher payment rates from insurers8 and providing physicians a more secure and stable lifestyle with regular hours, less time on-call, and little or no responsibility for managing the business side of practice.9. COPCPs 60 hospitalists, its transition care nurses, and its relationships with postacute care facilities aim to reduce patients hospital length of stay and avoid unnecessary admissions and readmissions. Epub 2017 Sep 21. A health plan executive stated, They are a good value propositiongood quality and cost. Despite its success to date, New West leadership and external observers believe that the group needs to grow larger if it is to remain independent. Fig 1 Data from Definitive Healthcare Independent group practices are attractive to physicians because they allow greater control over work schedules, care goals, and business decisions. Each group was positively regarded by external observers. New West employs a number of strategies to reduce hospital utilizationincluding provision of its own 24/7 hospitalist coverage, aggressive follow-up in home and postacute care settings to prevent readmissions, and provision of after-hours access to ambulatory care.19. Bethesda, MD 20894, Web Policies The executive added that COPCP, as a primary care based, physician-owned group has more opportunity to bend the cost curve compared with hospital-based groups burdened with hospitals high cost structure. This observer also argued that hospital-employed physicians and physicians in multispecialty groups face pressure to refer to specialists employed by their organization, whereas independent primary care groups can steer patients to hospitals and specialists who provide cost-efficient care. Disclaimer. Rising Hospital Employment of Physicians: Better Quality, Higher Costs? ACO = accountable care organization; CMIT = carotid intima-media thickness test; CT = computed tomography; HMO = health maintenance organization; IPA = independent practice association; MRI = magnetic resonance imaging; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home; SCHIP = State Childrens Health Insurance Program. This protocol can be found in Supplemental Appendix 1 (available at http://annfammed.org/content/14/1/16/suppl/DC1). Infinity has engaged in value-based contracting for both commercial and Medicare patients since 2006 through Oakland Southfield Physicians, a physician-owned independent practice association (IPA). Physician Health Partners serves as our primary care management services organization and provides support with contracting and network . To keep as much of the health care dollar as possible within our group, ACP sought risk contracts and developed imaging and laboratory services. After we designed and pilot tested a Web-based survey (Supplemental Appendix 2, available at http://annfa-mmed.org/content/14/1/16/suppl/DC1), we distributed it to a random sample of 50 physicians in each group. One or more team members conducted the interviews; a specially trained research coordinator took verbatim notes. Health Serv Res. We then selected 7 groups chosen to represent a variety of sizes and geographic areas; 5 agreed to participate. If you have young doctors, we are a better bet because they have a stake in the future. New West physicians are paid a base salary supplemented substantially by measures of individual performance, such as cost control, panel size, quality, and patient satisfaction (Table 1). Each group completed a short form supplying basic information about the group. Overall, physicians satisfaction with their clinical workload and work/life balance was moderate and somewhat lower than their satisfaction with their career and with their group. The previous work setting for nearly 50% of respondents was a solo or small group practice (Table 2); 25% joined their large primary care group from hospital employment and 21% from residency or fellowship training. At some point, ACP physicians could decide that the best way to prepare for retirement would be to monetize the value of their group by selling it. The https:// ensures that you are connecting to the A hospital administrator reinforced this view: ProHealth didnt end up in a multispecialty model with income disparities and disparate interests, where some partners are making 6 to 7 times what their other partners, who are working equally hard, are making. We identified 21 groups and studied 5 that varied in size and location. During the past few years, COPCP has increased its value-based contracting through Medicare Advantage plans and ACO-like contracts with health insurers.17 Health plans have helped to fund COPCPs 6 nurse care coordinators and development of its 46 patient-centered medical homes. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Keywords: Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting. Physicians Choice Medical Group of Santa Maria. From our list of physician groups, we can see that Southern California Permanente Medical Group is the largest with 17,514 practice members. Right now our major source of capital is our physicians. For us, only 15% of the profits from ancillaries goes to the doctors, the majority goes for ProHealth overhead. Filed June 26, 2023, 10 a.m. GMT. PMC With the exception of New West, which has long made risk contracting central to its strategy, they have only gradually moved into risk contracting, though at an accelerating pace. COPCP now includes 255 physicians at 53 practice sites; 69% are primary care physicians (20% general internal medicine) and an additional 22% are hospitalists (Table 1). Third, despite large independent primary care groups potential advantages in a risk-contracting environment, success will require capital for infrastructure and growth.31 Each group perceived growth as important to gain increasing economies of scale to build health information technology and care management infrastructures necessary to succeed in value-based contracting and to spread the risk for the costs of care over larger numbers of patients. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale. Int J Med Inform. Bookshelf Central Ohio Primary Care Physicians (COPCP) was created in 1996 from the merger of 11 practices totaling 33 physicians. I have never seen in 20 years splintering off of physicians from New West; they are very different from other groups and IPAs. Overall, 81% of the groups primary care physicians reported being somewhat or very satisfied with their career in medicine (Table 3). MeSH Sincerely, SAN DIEGO PHYSICIANS MEDICAL GROUP/SCRIPPS PHYSICIANS MEDICAL GROUP. The groups are similar in their use of multiple small rather than a few large practice sites, their volume-based methods for paying physicians (again, with the exception of New West), their extensive development of ancillary services, and their struggle to balance physician autonomy with group objectives (eg, limiting the pool of specialists to whom physicians refer). Blaum CS, Rosen J, Naik AD, Smith CD, Dindo L, Vo L, Hernandez-Bigos K, Esterson J, Geda M, Ferris R, Costello D, Acampora D, Meehan T, Tinetti ME. COPCP physicians pay their sites overheadstaff and office expenses, including rentand contribute to COPCPs administrative costs. Their scale makes it possible for them to develop systematic processes to improve the quality of care, while their multiple practice sites offer patients easy geographic access and the small practice environment that some patients seem to prefer. Risk contracting and primary care gatekeeping were gaining popularity, and hospitals and large corporations were buying primary care physician practiceswhich ACP physicians wanted to avoid. Overall, most of the groups physicians reported agreeing or strongly agreeing that they had autonomy in practicing medicine, less pressure from such external entities as hospitals, more cohesion because they were a primary care group, and easy-access-to specialty care. In this article we describe 5 large primary care groups, their advantages and disadvantages, and the challenges they face. In free-text comments in the questionnaire, some Infinity physicians expressed frustration with their electronic health record (EHR) system. Federal government websites often end in .gov or .mil. By adding already existing small primary care practices, ACP grew to include 54 sites with 130 physicians. official website and that any information you provide is encrypted 2016 Mar;14(2):99. doi: 10.1370/afm.1914. ProHealth owns a large clinical laboratory, 7 diagnostic imaging centers, a sleep center, a hearing center, 4 physical therapy centers, a Sinus Institute, and an attention deficit hyperactivity disorder center: The profits afford us to have a better infrastructure. Because weve provided cost-effective care and were responsible for where the dollars were flowing, it allowed us to make significant amounts of money. Physicians Medical Group of San Jose. Find a Physician Group ACEP's Emergency Medicine Group Database is the most comprehensive listing available that allows you to search based on group size, location, whether the group pays your ACEP dues, and other criteria. HHS Vulnerability Disclosure, Help See Supplemental Appendix 2 at http://annfammed.org/content/14/1/16/suppl/DC1 for a copy of the survey instrument. Ascension Medical Group: 6,300 4. Dr Lynch and Dr Staub are leaders in ProHealth Physicians. Recently, ProHealth has been signing agreements with selected specialist groups, home health agencies, and skilled nursing facilities that describe mutual expectations in terms of access, communication, collaborative care, and transitional care management. MultiCultural Medical Group, Inc. My Family Medical Group. Throughout the article, quotes come from group leaders unless otherwise specified. Increasingly, physicians are choosing to become employed by large organizations.10,11 Some join large multispecialty or single-specialty medical groups. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Proportion of physicians in large group practices continued to grow in 200911, Horizontal and vertical integration of physicians: a tale of two tails, Annual Review of Health Care Managmenet: Revisiting the Evolution of Health Systems Organization, Hospitals race to employ physiciansthe logic behind a money-losing proposition. They were early adopters of the state of Michigan program for patient-centered medical homes. The groups differ in size, extent of risk contracting, and employment of hospitalists. ProHealth is slugging it out with cash-rich hospitals, which offer physicians substantial sums for their practices: We dont acquire practices from the cash perspective the way they do. The site is secure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. The effect of financial incentives on the quality of health care provided by primary care physicians. Very few physicians and policy experts are aware of these groups; we have been unable to find a peer-reviewed article on this topic. They are financially savvy and have a good clinical reputation as PCPs [primary care physicians]. The market is anticipated to grow from USD 279.65 billion in 2022 to USD 360.47 billion by 2029, exhibiting a CAGR of 3.7% during the forecast period. DuPage Medical Group became Duly Health and Care on September 15, 2021. Each group was positively regarded by external observers. Acurity has the highest NPR at $82.8 billion. Second, ownership of imaging facilities can be advantageous in risk contracting, because these facilities cost less than competing hospital-based facilities. An outside observer stated: This opportunity is often not available, however, and many physicians are becoming employed by hospitals.12,13 For primary care physicians, an additional option is available: the large, physician-owned, primary care medical group. They make it possible to work in the small practice setting that some physicians prefer while gaining substantial help with the business side of medicine plus economies of scale to develop health information technology, ancillary services, and care management processes. Large Independent Primary Care Medical Groups Spending per Medicare Beneficiary Is Higher in Hospital-Owned Small- and Medium-Sized Physician Practices. Impact of the HITECH financial incentives on EHR adoption in small, physician-owned practices. Funding support: The Commonwealth Fund supporting this project (grant #20130522). This opportunity is often not available, however, and many physicians are becoming employed by hospitals.12,13 For primary care physicians, an additional option is available: the large, physician-owned, primary care medical group. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Our Client Services Department is available to answer any questions you may have at (858) 824-7000 during normal business hours. 1Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, 2ProHealth Physicians, Farmington, Connecticut. We wanted to describe these groups, their advantages, and their challenges. Primary care physicians are generally perceived to be essential for organizations to succeed at improving population health and value-based purchasing,23 but relatively few US physicians choose to practice primary care.2426 Our findings suggest that large physician-owned primary care groups can present an attractive option. ACP engages in ACO-like contracts with health plans, participates in a Medicare Shared Savings Program through the Commonwealth Primary Care ACO, and is applying to the Centers for Medicare & Medicaid Services to start its own ACO. COPCPs extensive ancillary services have become less profitable as payment rates for these services decline. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. ACP leaders and external observers suggest 3 challenges going forward: first, declines in reimbursement for ancillary servicesespecially for computed tomography and magnetic resonance imaginghave reduced an important source of ACP revenue. These primary care groups potential appears to be far from fully realized. ProHealths size gives the group leverage with specialists, though it has been used lightly, in part because physicians within ProHealth have their own opinions about where they want to refer patients. One-half of Infinity sites have National Committee for Quality Assurance Medical Home designation; all have Blue Cross of Michigan medical home designation. The substantial cost savings and quality bonuses that New West gains through risk contracting enable the groups physicians to earn considerably more than the average US primary care physician or primary care physicians in the other groups in this study. Emergency Medicine Group Database 1 Permanente Medical Groups (Oakland, Calif.) Total physician affiliations: 19,179 Unique physicians: 14,757 Medical group count: 578 No. That dynamic doesnt work. We wanted to describe these groups, their advantages, and their challenges. ProHealth team members did not read the interviews with ProHealth leaders or external observers of ProHealth. Unable to load your collection due to an error, Unable to load your delegates due to an error. Covid-19 made it worse. We sent a draft of our findings to each group. the contents by NLM or the National Institutes of Health. Arizona Community Physicians (ACP) was created in 1994 through a merger of 2 groups totaling 9 primary care physicians. An important and uncommon strength of our study is that we are able to triangulateto compare information from interviews with group leaders with information from interviews with external observers and with survey responses from groups rank-and-file physicians. Characteristics of Physicians in the Primary Care Groups, Central Ohio Primary Care Physicians (COPCP) was created in 1996 from the merger of 11 practices totaling 33 physicians. New West takes full risk for primary care and specialist physician services and substantial shared risk for hospital and ancillary services, and claims to have been very successful financially in these contracts year after yeara claim that was supported in our interviews with external observers. Bethesda, MD 20894, Web Policies J Am Geriatr Soc. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. It would be very difficult. Physicians are paid almost entirely based on the volume of services they generate. Overall, 81% of the groups primary care physicians reported being somewhat or very satisfied with their career in medicine (Table 3). 2013;15:39-117. doi: 10.1108/s1474-8231(2013)0000015009. Chest Medicine Associates (CMA), Portland Gastroenterology Associates (PGA), OA Centers for Orthopaedics (OA), and Spectrum Medical Group (SMG) are the founding members of the newly formed Maine Specialty . Careers. Browse 1099 Jobs Vendor Registration Learn six elements of a physician group board that serves group-wide interests, focuses on governance rather than management, and efficiently executes its role. OmniCare Medical Group. Enter multiple addresses on separate lines or separate them with commas. Though large groups negotiating leverage can lead to higher payment rates from health insurers, primary care costs are only 5% of health care costs.27 When engaged in risk contracting, primary care groups can focus on controlling the other 95% of costs without conflicting incentives to keep specialists busy or hospital beds filled.2729 This logic is leading venture capital funds to flow into corporations that focus on engaging multiple independent primary care physician practices in ACO contracts.27,30. Each group was positively regarded by external observers. Physicians face a rapidly changing world of value-based payment,1 public reporting of physician performance,2 electronic health records (EHRs), patient-centered medical homes,3 and accountable care organizations (ACOs).4,5 Success is likely to require substantial investments in health information technology and skilled leadership and staff.6,7 Large organizations have the scale to make these investments while negotiating higher payment rates from insurers8 and providing physicians a more secure and stable lifestyle with regular hours, less time on-call, and little or no responsibility for managing the business side of practice.9. Healthc (Amst). Received 2015 Aug 25; Revised 2015 Oct 19; Accepted 2015 Nov 8. Infinity has had stable leadership, and continues to maintain its independence, but it has not grown as rapidly as anticipated, raising the possibility that the group could at some point become part of a larger multispecialty group or sell to a hospital. Open Med. Infinitys care managers have been funded via multiple demonstration projects. Multispecialty physician networks in Ontario. One-half of Infinity sites have National Committee for Quality Assurance Medical Home designation; all have Blue Cross of Michigan medical home designation. The .gov means its official. With the exception of ProHealth, employment of hospitalists is related to the groups extent of risk contracting. Infinity has had stable leadership, and continues to maintain its independence, but it has not grown as rapidly as anticipated, raising the possibility that the group could at some point become part of a larger multispecialty group or sell to a hospital. Responses from the 3 sources were consistent. Only 5.4% of physicians cited their groups clinical quality programs as a reason for joining. Epub 2016 Sep 9. We triangulated responses from group leaders, group physicians, and external observers to identify key themes. Some ProHealth physicians criticized their groups large investments in infrastructure to succeed at risk contracting, using funds that could otherwise go to physicians. New West Physicians was created in 1994 by 18 primary care physicians in 6 practices after 2 years of nearly weekly meetings. We couldnt even exist without this. This level of satisfaction is as good or better than that reported in the literature, which is somewhat dated21,22 and does not reflect possibly increasing physician dissatisfaction.22 Seventy-four percent of primary care physicians reported being somewhat or very satisfied with their medical group (no comparable data exist). Independent practice associations: Advantages and disadvantages of an alternative form of physician practice organization. New West now has 65 physicians at 17 sites in the Denver area. The Ukrainian president said S-300 missiles were used to carry out the deadly attacks. Risk contracting and primary care gatekeeping were gaining popularity, and hospitals and large corporations were buying primary care physician practiceswhich ACP physicians wanted to avoid. A hospital executive stated: eCollection 2013. Independent Contractor. This is a very expensive transition to develop the tools to develop population management. A health plan executive states: They have been good partnersfavorable quality and costs., For 2013, ProHealth earned $9 million in pay-for-performance bonuses: If we hit them (efficiency targets, cost of care, access targets) then we make moneythat has become a larger revenue stream than ancillary services., As ProHealth assumes more responsibility for the cost and quality of care, it is beginning to work with hospitals (eg, hospitals notify ProHealth promptly when a ProHealth patient arrives in the emergency department or is about to be discharged from the hospital) and specialists to gain better coordination. Infinity has a diagnostic testing center that provides imaging and laboratory services. Duly Health and Care is the largest independent, multi-specialty physician-directed medical group in the Midwest with more than 900 primary care and specialty . This is how the CEO of a large independent medical group described his current view of the dynamics in the market during a recent meeting. Characteristics of Physicians in the Primary Care Groups. Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D. Cochrane Database Syst Rev. 2017 Mar;5(1-2):46-52. doi: 10.1016/j.hjdsi.2016.08.003. HealthCare Partners IPA: 5,029 5. Other form of risk for patient care, including ACO-like or pay-for-performance contracts with health insurers, No. For example: Our EHR is a disaster, which has slowed down productivity and required many additional hours of work with lower income.. SK&A named the 50 largest medical groups by the number of affiliated physicians and included information on the number of offices per group and average number of physicians per office. government site. This decision may become particularly pressing as groups physiciansand their leadersapproach retirement. The 5 groups that agreed to participate were Arizona Community Physicians, Central Ohio Primary Care Physicians, Infinity Primary Care, New West Physicians, and ProHealth Physicians (Table 1). HHS Vulnerability Disclosure, Help ProHealth leadership was aware of this problem: 1. Methods: The most common reasons for joining the groups were to gain negotiating leverage with health insurers, to gain the groups expertise in the business side of medicine, allowing me to focus on practicing medicine, the potential for higher income, and the potential for greater autonomy (Table 4). The group was created because PHO [physician hospital organization] structures often have a pecking order between the relationships of hospital and specialists and PCPs were at the caboose. Furthermore, Larger multispecialty groups spend a lot of time on resources and how they are going to split the compensation. These contracts are more profitable for the group than traditional health insurer contracts; Infinity has gained bonuses for both cost and quality performance each year: We couldnt even exist without this.
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