Virginia Advance Sheet February 2013

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New fact sheet provides the three steps you can take if you were recently diagnosed with gonorrhea or chlamydia, including resources to help you talk to your partner. August 3, Sexually Transmitted Diseases. Section Navigation.

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New fact sheet provides the three steps you can take if you were recently diagnosed with gonorrhea or chlamydia, including resources to help you talk to your partner. August 3, Sexually Transmitted Diseases. They call for policies to help small practices continue to advance the Triple Aim and profit from economies of scale without sacrificing the benefits of being small.

They conclude extension programs and community health teams have the potential to facilitate transformation within solo and small practices. In the turbulent U.

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In the first peer-reviewed article on the topic, researchers studied five different primary care physician groups varying in size and location and identified their advantages and disadvantages, as well as the challenges they face. Triangulating survey and interview responses from group leaders, group physicians and external observers, the researchers found the scale of the groups makes it possible for them to develop laboratory and imaging services, health information technology and quality improvement infrastructure, while their multiple practice sites offer patients easy geographic access and the small practice environment that many patients and physicians prefer.


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The authors found the groups differed in the extent to which they engaged in value-based contracting, though all were moving to increase the amount of financial risk they took on for their quality and cost performance. They note that unlike hospital-employed and multi-specialty groups, these independent groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high.

Some, however, indicated they were under pressure to sell to organizations that could provide capital for additional infrastructure to engage in value-based contracting and provide substantial income to physicians from the sale. Of note, the groups' physicians reported only moderate satisfaction with their clinical workload and their work-life balance, suggesting that the groups have not fully resolved the difficulties of practicing primary care medicine.

The authors conclude that large independent primary care physician 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.

Mostashari cites recent evidence demonstrating small practices have lower average cost per patient, fewer preventable hospital admissions and lower readmission rates than larger, independent- and hospital-owned practices.

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In contrast, the main effect of consolidation, he asserts, is not true clinical integration but market power used to extract higher prices from payers and to prevent any efficiencies from being passed on to payers and consumers. Mostashari calls for solo and small practices to link up with others who share a dedication to the mission of value-based care and the value of small practices. He lays out numerous benefits of this coupling: it provides a collaborative network of peers, allows for insights from population health models, provides scale needed to negotiate value-based contracts and spread risk, and enables practices to procure the necessary technologies and employ individuals who can use analytics to draw insights from data or have the regulatory and billing know-how for a practice to maximize revenue.

Moreover, he calls on policymakers and stakeholders to facilitate the partnerships, technologies and policies necessary for small, independent practices to thrive in a value-based health care system. Despite the headlong rush of practices toward quality payment, two family physicians from a rural Colorado micro practice explain why their experience suggests it may not make sense for small rural practices. They detail how the practice's many quality improvement initiatives did not result in any improvement -- largely because the practice was already performing at a high level of cost savings and there was little room for improvement.

The authors question the validity of current quality reimbursement models, asserting that the Patient-Centered Primary Care Collaborative data does not conclusively show a practice-level improvement in the Triple Aim by movement to the Patient Centered Medical Home. Instead, they contend, these initiatives may be unwittingly driving already high-performing small practices to consolidate or forcing them into larger institutions.

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They conclude that until there is definitive proof that the surrogate measures of quality from divergent and competing entities, many of whom are seeking to control cost over quality, actually do what they say, practices should fully assess whether the PCMH will improve their practice. The appeal for family medicine and other primary care organizations to be drivers of quality measures that make sense, and rather than joining larger groups or participating in externally driven quality programs, they call for small practices to consider a return to a transparent, free market model such as direct primary care in which there is a direct financial relationship between patients and health care providers in which the consumer judges quality and cost directly.

Researchers in Canada examine the association of family physicians' panel size with quality of care and health service use.

Analyzing quality data on 4, physicians in Ontario, Canada, with panel sizes between 1, and 3, patients, researchers found increasing panel size was associated with small decreases in cancer screening, continuity and comprehensiveness, but little difference in chronic disease management quality or access indicators.

Specifically, they found the likelihood of patients' being up-to-date on cervical, colorectal and breast cancer screening showed relative decreases of 8 percent, 6 percent and 5 percent, respectively, with increasing panel size. Eight chronic care indicators showed no significant association with panel size, but increasing panel size was associated with an 11 percent relative increase in hospitalization rates for ambulatory-care-sensitive conditions and an 11 percent decrease in non-emergency department visits.

Of note, data did show continuity was highest with medium panel sizes and comprehensiveness had a small decrease with increasing panel size. Because they found no panel size threshold above which quality of care suffered, these findings, they conclude, do not support policy measures such as thresholds or caps that reduce payments to physicians with large panel sizes. They postulate that physicians who take on larger patient panels may be able to do so without compromising care quality because personal or practice characteristics, such as communication style, organizational climate and systematic measures to optimize practice access, allow them to provide effective and efficient care.

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