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Crowley R, Pugach D, Williams M, Goldman J, Hilden D, Schultz AF, Beachy M. Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:65-67. [PMID: 38145573 DOI: 10.7326/m23-2260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - David Pugach
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Margo Williams
- American College of Physicians, Washington, DC (R.C., D.P., M.W.)
| | - Jason Goldman
- Charles E. Schmidt College of Medicine, Boca Raton, Florida (J.G.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | | | - Micah Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.B.)
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Huang YL, Berg BP, Lampman MA, Rushlow DR. Modeling Family Medicine Provider Care Team Design to Improve Patient Care Continuity. Qual Manag Health Care 2023; 32:222-229. [PMID: 36940371 DOI: 10.1097/qmh.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Continuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have multiple responsibilities in addition to clinical duties or panel management time (PMT). These competing time demands limit providers' clinical availability. One way to mitigate the impact on patient access and care continuity is to create provider care teams to collectively share the responsibility of meeting patients' needs. METHODS This study presents a descriptive characterization of patient care continuity based on provider types and PMT. Care continuity was measured by the percentage of patient a ppointments s een by a provider in their o wn c are t eam (ASOCT) with the aim of reducing the variability of provider care team continuity. The prediction method is iteratively developed to illustrate the importance of the individual independent components. An optimization model is then used to determine optimal provider mix in a team. RESULTS The ASOCT percentage in current practice among care teams ranges from 46% to 68% and the per team number of MDs varies from 1 to 5 while the number of nurse practitioners and physician assistants (NP/PAs) ranges from 0 to 6. The proposed methods result in the optimal provider assignment, which has an ASOCT percentage consistently at 62% for all care teams and 3 or 4 physicians (MDs) and NP/PAs in each care team. CONCLUSIONS The predictive model combined with assignment optimization generates a more consistent ASOCT percentage, provider mix, and provider count for each care team.
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Affiliation(s)
- Yu-Li Huang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (Drs Huang and Lampman); Division of Health Policy and Management School of Public Health, University of Minnesota, Minneapolis (Dr Berg); and Department of Family Medicine, Mayo Clinic, Rochester, Minnesota (Dr Rushlow)
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Whiting A, Poolman AE, Misra A, Gordon JE, Angstman KB. Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels. Mayo Clin Proc Innov Qual Outcomes 2023; 7:256-261. [PMID: 37388418 PMCID: PMC10300043 DOI: 10.1016/j.mayocpiqo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP). Patients and Methods We retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening. Results The study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%; P<.01). The SPP clinicians showed improved quality metrics compared with that of the IPP clinicians for the percentage of patients with cervical cancer screening (79.1% vs 74.2%; P<.01). The mean percentage of the panels achieving optimal diabetes control, hypertension control, colon cancer screening, and breast cancer screening were not significantly different between IPP and SPP panels. Conclusion This study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.
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Affiliation(s)
- Adria Whiting
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - April E. Poolman
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Fairmont, MN
| | - Artika Misra
- Department of Family Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN
| | - Joel E. Gordon
- Department of Family Medicine and Community Health Madison, University of Wisconsin, Madison
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Lu MA, O'Toole J, Shneyderman M, Brockman S, Cumpsty-Fowler C, Dang D, Herzke C, Rand CS, Sateia HF, Van Dyke E, Eakin MN, Daugherty Biddison EL. "Where You Feel Like a Family Instead of Co-workers": a Mixed Methods Study on Care Teams and Burnout. J Gen Intern Med 2023; 38:341-350. [PMID: 36038756 PMCID: PMC9422940 DOI: 10.1007/s11606-022-07756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.
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Affiliation(s)
- Monica A Lu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacqueline O'Toole
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Matthew Shneyderman
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Carolyn Cumpsty-Fowler
- Johns Hopkins Health System, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Carrie Herzke
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Heather F Sateia
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Michelle N Eakin
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - E Lee Daugherty Biddison
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA.
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Bernard ME, Halasy MP, Rushlow DR, Sobolik GJ, Garrison GM, Matthews MR, Allen SV, Thacher TD. The effect of primary care clinician type and care team characteristics on health care costs. J Eval Clin Pract 2022; 28:1055-1060. [PMID: 35434886 DOI: 10.1111/jep.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate health care costs as a function of assigned primary care clinician type and care team characteristics. METHODS Administrative data were collected for 68 family medicine clinicians (40 physicians and 28 nurse practitioners [NPs]/physician assistant [PAs]), on 11 care teams (variable MD, NP and PA on teams), caring for 77,141 patients. We performed a generalized linear mixed multivariable regression model of standardized per member per month (PMPM) median cost as the outcome, with four practice sites included as random effects. RESULTS In bivariate analysis, cost was higher in physicians than NP/PAs, in more complex patients, and associated with emergency department (ED) visit rate. On multivariate analysis, patient complexity, ED visit rate and higher patient experience ratings were independently associated with greater PMPM cost. More time in practice was associated with lower PMPM cost. In the adjusted multivariate model, physicians had 8.3% lower median PMPM costs than NP/PAs (p = 0.046). CONCLUSIONS The primary drivers of greater PMPM cost were patient complexity, ED visits and patient satisfaction.
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Affiliation(s)
- Matthew E Bernard
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald J Sobolik
- Employee and Community Health, Primary Care and Population Health, Rochester, Minnesota, USA
| | | | - Marc R Matthews
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Brzozowski SL, Cho H, Shuman CJ, Scott LD, Mundt MP, Steege LM. Primary Care Nurses' Perception of Leadership and the Influence of Individual and Work Setting Characteristics: A Descriptive Study. J Nurs Manag 2022; 30:2751-2762. [PMID: 35939322 PMCID: PMC10086998 DOI: 10.1111/jonm.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS To describe primary care nurses' perceptions of their formal leaders' leadership behaviors and outcomes and explore differences based upon nurses' individual and work setting characteristics. BACKGROUND Formal nursing leadership is positively associated with patient, nurse workforce, and organizational outcomes, yet no studies have examined primary care nurses' perception of formal leadership behaviors and outcomes in the United States. METHODS Cross-sectional survey data from 335 primary care nurses were analyzed to assess perceived leadership behaviors associated with transformational, transactional, and passive-avoidant leadership styles, perceived leadership outcomes, and individual and work setting characteristics. RESULTS Positive leadership behaviors (transformational) were lower than those reported for other settings. There were significant differences in nurses' perceptions of their leaders' leadership behaviors and outcomes based upon individual and work setting characteristics. CONCLUSION This study confirmed differences in perception of leadership and that individual and work setting characteristics influence nurses' perception of their leaders in primary care. IMPLICATIONS FOR NURSING MANAGEMENT Leaders must be versatile and consider the unique needs of each staff member and the influence of clinic characteristics.
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Affiliation(s)
| | | | - Clayton J Shuman
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan
| | | | - Marlon P Mundt
- Departments of Family Medicine and Community Health and Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
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Mayo-Smith MF, Robbins RA, Murray M, Weber R, Bagley PJ, Vitale EJ, Paige NM. Analysis of Variation in Organizational Definitions of Primary Care Panels: A Systematic Review. JAMA Netw Open 2022; 5:e227497. [PMID: 35426924 PMCID: PMC9012968 DOI: 10.1001/jamanetworkopen.2022.7497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Primary care panel size plays an increasing role in measuring primary care provider (ie, physicians and advanced practice providers, which include nurse practitioners and physician assistants) workload, setting practice capacity, and determining pay and can influence quality of care, access, and burnout. However, reported panel sizes vary widely. OBJECTIVE To identify how panels are defined, the degree of variation in these definitions, the consequences of different definitions of panel size, and research on strengths of different approaches. EVIDENCE REVIEW Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, MEDLINE, Web of Science, Embase, and Dissertations and Theses Global databases were searched from inception to April 28, 2021, for subject headings and text words to capture concepts of primary care panel size. Article review and data abstraction were performed independently by 2 reviewers. Main outcomes reported included rules for adding or removing patients from panels, rules for measuring primary care provider resources, consequences of different rules on reported panel size, and research on advantages and disadvantages of different rules. FINDINGS The literature search yielded 1687 articles, with 294 potentially relevant articles and 74 containing relevant data. Specific practices were identified from 29 health care systems and 5 empanelment implementation guides. Patients were most commonly empaneled after 1 primary care visit (24 of 34 [70.6%]), but some were empaneled only after several visits (5 [14.8%]), enrollment in a health plan (4 [11.8%]) or any visit to the health care system (1 [3.0%]). Patients were removed when no visit had occurred in a specified look-back period, which varied from 12 to 42 months. Regarding primary care provider resources, half of organizations assigned advanced practice providers independent panels and half had them share panels with a physician, increasing the physician's panel by 50% to 100%. Analyses demonstrated that changes in individual rules for adding patients, removing patients, or estimating primary care provider resources could increase reported panel size from 20% to 100%, without change in actual primary care provider workload. No research was found investigating advantages of different definitions. CONCLUSIONS AND RELEVANCE Much variation exists in how panels are defined, and this variation can have substantial consequences on reported panel size. Research is needed on how to define primary care panels to best identify active patients, which could contribute to a widely accepted standard approach to panel definition.
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Affiliation(s)
- Michael F. Mayo-Smith
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire
- Harvard Medical School Center for Primary Care, Boston, Massachusetts
| | | | - Mark Murray
- Mark Murray and Associates, Sacramento, California
| | | | | | | | - Neil M. Paige
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles
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Paradis KC, Ryan KA, Schmid S, Moran JM, Laucis AM, Chapman CH, Bott-Kothari T, Prisciandaro JI, Simiele SJ, Balter JM, Matuszak MM, Narayana V, Jagsi R. Gender Differences in Work-Life Integration Among Medical Physicists. Adv Radiat Oncol 2021; 6:100724. [PMID: 34278052 DOI: 10.1016/j.adro.2021.100724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To generate an understanding of the primary concerns facing medical physicists regarding integration of a demanding technical career with their personal lives. Methods and Materials In 2019, we recruited 32 medical physics residents, faculty, and staff via emails to US medical physics residency program directors to participate in a 1-hour, semistructured interview that elicited their thoughts on several topics, including work–life integration. Standard techniques of qualitative thematic analysis were used to generate the research findings. Results Of the participants, 50% were women and 69% were non-Hispanic White individuals, with a mean (SD) age of 37.5 (7.4) years. They were evenly split between residents and faculty or staff. Participant responses centered around 5 primary themes: the gendered distribution of household responsibilities, the effect of career or work on home and family life, the effect of family on career or work, support and strategies for reconciling work–life conflicts, and the role of professional societies in addressing work–life integration. Participants expressed concern about the effect of heavy workloads on home life, with female respondents more likely to report carrying the majority of the household burden. Conclusions Medical physicists experience challenges in managing work–life conflict amid a diverse array of personal and professional responsibilities. Further investigations are needed to quantitatively assess the division of work and household labor by gender in medical physics, particularly after the outbreak of the COVID-19 pandemic, but this study's qualitative findings suggest that the profession should consider ways to address root causes of work–life conflict to promote the future success and well-being of all medical physicists, and perhaps women in particular.
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Bernard ME, Laabs SB, Nagaraju D, Allen SV, Halasy MP, Rushlow DR, Garrison GM, Maxson JA, Matthews MR, Sobolik GJ, Lampman MA, Foss RM, Rosas SL, Thacher TD. Clinician Care Team Composition and Health Care Utilization. Mayo Clin Proc Innov Qual Outcomes 2021; 5:338-346. [PMID: 33997633 PMCID: PMC8105520 DOI: 10.1016/j.mayocpiqo.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team characteristics associated with greater utilization. Patients and Methods We retrospectively analyzed administrative data collected from January 1 to December 31, 2017, of 420 family medicine clinicians (253 physicians, 167 nurse practitioners/physician assistants [NP/PAs]) with patient panels in an integrated health system in 59 Midwestern communities serving rural and urban areas in Minnesota, Wisconsin, and Iowa. These clinicians cared for 419,581 patients through 110 care teams, with varying numbers of physicians and NP/PAs. Primary outcome measures were rates of ED visits, hospitalizations, and readmissions. Results The proportion of physician full-time equivalents on the team was unrelated to rates of ED visits (rate ratio [RR] = 0.826; 95% confidence interval [CI], 0.624 to 1.063), hospitalizations (RR = 0.894; 95% CI, 0.746 to 1.072), or readmissions (RR = –0.026; 95% CI, 0.364 to 0.312). In separate multivariable models adjusted for clinician and practice-level characteristics, the rate of ED visits was positively associated with mean panel hierarchical condition category (HCC) score, urban vs rural setting, NP/PA vs physician, and lower years in practice. The rate of inpatient admissions was associated with HCC score, and 30-day hospital readmissions were positively associated with HCC score, lower years in practice, and male clinicians. Conclusion Care team physician and NP/PA composition was not independently related to utilization. More complex panels had higher rates of ED visits, hospitalization, and readmissions. Statistically significant differences between physician and NP/PA panels were only evident for ED visits.
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Affiliation(s)
| | - Susan B Laabs
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Julie A Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | | | - Gerald J Sobolik
- Department of Health Care Administration, Mayo Clinic, Rochester, MN
| | | | - Randy M Foss
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Steven L Rosas
- Department of Family Medicine, Mayo Clinic, Rochester, MN
| | - Tom D Thacher
- Department of Family Medicine, Mayo Clinic, Rochester, MN
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Patel RA, Torabi SJ, Kasle DA, Pivirotto A, Manes RP. Role and Growth of Independent Medicare-Billing Otolaryngologic Advanced Practice Providers. Otolaryngol Head Neck Surg 2021; 165:809-815. [PMID: 33687283 DOI: 10.1177/0194599821994820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the role and growth of independently billing otolaryngology (ORL) advanced practice providers (APPs) within a Medicare population. STUDY DESIGN Retrospective cross-sectional study. SETTING Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data Files, 2012-2017. METHODS This retrospective review included data and analysis of independent Medicare-billing ORL APPs. Total sums and medians were gathered for Medicare reimbursements, services performed, number of patients, and unique Current Procedural Terminology (CPT) codes used, along with geographic and sex distributions. RESULTS There has been near-linear growth in number of ORL APPs (13.7% to 18.4% growth per year), with a 115.4% growth from 2012 to 2017. Similarly, total Medicare-allowed reimbursement (2012: $15,568,850; 2017: $35,548,446.8), total number of services performed (2012: 313,676; 2017: 693,693.7), and total number of Medicare fee-for-service (FFS) patients (2012: 108,667; 2017: 238,506) increased. Medians of per APP number of unique CPT codes used, Medicare-allowed reimbursement, number of services performed, and number of Medicare FFS patients have remained constant. There were consistently more female APPs than male APPs (female APP proportion range: 71.3%-76.7%). Compared to ORL physicians, there was a significantly greater proportion of APPs practicing in a rural setting as opposed to urban settings (2017: APP proportion 13.6% vs ORL proportion 8.4%; P < .001). CONCLUSION Although their scope of practice has remained constant, independently billing ORL APPs are rapidly increasing in number, which has led to increased Medicare reimbursements, services, and patients. ORL APPs tend to be female and are used more heavily in regions with fewer ORL physicians.
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Affiliation(s)
- Rahul A Patel
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA.,Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J Torabi
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David A Kasle
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Allison Pivirotto
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - R Peter Manes
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
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Meyerink BD, Lampman MA, Laabs SB, Foss RM, Garrison GM, Angstman KB, Sobolik GJ, Halasy MP, Fischer KJ, Rosas SL, Maxson JA, Rushlow DR, Horn JL, Matthews MR, Nagaraju D, Thacher TD. Relationship of Clinician Care Team Composition and Diabetes Quality Outcomes. Popul Health Manag 2020; 24:502-508. [PMID: 33216689 DOI: 10.1089/pop.2020.0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective was to determine if a greater proportion of physician full-time equivalent (FTE%) relative to nurse practitioners/physician assistants (NPs/PAs) on care teams was associated with improved individual clinician diabetes quality outcomes. The authors conducted a retrospective cross-sectional study of 420 family medicine clinicians in 110 care teams in a Midwest health system, using administrative data from January 1, 2017 to December 31, 2017. Poisson regression was used to examine the relationship between physician FTE% and the number of patients meeting 5 criteria included in a composite metric for diabetes management (D5). Covariates included panel size, clinician type, sex, years in practice, region, patient satisfaction, care team size, rural location, and panel complexity. Of the 420 clinicians, 167 (40%) were NP/PA staff and 253 (60%) were physicians. D5 criteria were achieved in 37.9% of NP/PA panels compared with 44.5% of physician panels (P < .001). In adjusted analysis, rate of patients achieving D5 was unrelated to physician FTE% on the care team (P = .78). Physicians had a 1.082 (95% confidence interval 1.007-1.164) times greater rate of patients with diabetes achieving D5 than NPs/PAs. Clinicians at rural locations had a .904 (.852-.959) times lower rate of achieving D5 than those at urban locations. Physicians had a greater rate of patients achieving D5 compared with NPs/PAs, but physician FTE% on the care team was unrelated to D5 outcomes. This suggests that clinician team composition matters less than team roles and the dynamics of collaborative care between members.
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Affiliation(s)
| | - Michelle A Lampman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan B Laabs
- Department of Family Medicine, Mayo Clinic, Mankato, Minnesota, USA
| | - Randy M Foss
- Department of Family Medicine, Mayo Clinic, Lake City, Minnesota, USA
| | - Gregory M Garrison
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Kurt B Angstman
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Gerald J Sobolik
- Primary Care and Population Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael P Halasy
- Department of Physical Medicine and Rehabilitation, Spine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin J Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven L Rosas
- Department of Family Medicine, Mayo Clinic, Menomonie, Wisconsin, USA
| | - Julie A Maxson
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - David R Rushlow
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Horn
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Marc R Matthews
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Darshan Nagaraju
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
| | - Tom D Thacher
- Department of Family Medicine and Mayo Clinic, Rochester, Minnesota, USA
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