SEARCH · PubMed Health

Results for “Independent Practice Associations”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMed2004

The alignment and blending of payment incentives within physician organizations.

OBJECTIVE: To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. DATA SOURCES: Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. STUDY DESIGN: We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. PRINCIPAL FINDINGS: Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. CONCLUSIONS: Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization.

Capitation Fee↗

PubMed1995

Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study.

OBJECTIVE: To compare the outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus (NIDDM) who were cared for in three different systems of care and by generalist and subspecialist physicians. DESIGN: An observational study with follow-up at three periods: (1) a 2-year study of 532 patients with hypertension and 170 patients with NIDDM who had entrance and exit histories, physical examinations, and laboratory tests; (2) a 4-year follow-up of 1044 patients with hypertension and 317 patients with NIDDM based on patient-reported functional status; and (3) 7-year mortality for 1296 patients with hypertension and 424 patients with NIDDM. SETTING AND PARTICIPANTS: Patients sampled from health maintenance organizations, large multispecialty groups, and solo or single-specialty group practices in Boston, Mass, Los Angeles, Calif, and Chicago, Ill. Patients were designated as belonging to one of three systems of care: fee for service; prepaid patients in solo or small single-specialty groups or in large multispecialty group practices, referred to as independent practice associations; and staff-model health maintenance organizations. The principal providers were family practitioners, general internists, cardiologists, or endocrinologists. MAIN OUTCOME MEASURES: Physiological, functional, and mortality. For hypertension, we measured blood pressure and stroke incidence. For NIDDM, we measured blood pressure, glycosylated hemoglobin level, visual function, vibration sense, ulcers and infections in the feet, and albumin excretion rate. Functional outcomes were assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Mortality was assessed for the 7 years following the entrance examination. RESULTS: We found no evidence that any one system of care or physician specialty achieved consistently better 2-year or 4-year outcomes than others for patients with NIDDM or hypertension. Endocrinologists appeared to achieve better foot-ulcer and infection outcomes for patients with NIDDM, particularly when compared with family practitioners. However, no other specialist differences were found in any individual measures for either condition. Moreover, no adjusted mortality differences among systems or among physicians specialties were observed in the 7-year follow-up period. CONCLUSION: No meaningful differences were found in the mean health outcomes for patients with hypertension or NIDDM, whether they were treated by different care systems or by different physician specialists. Although prepaid medicine relies more heavily on generalist physicians than does fee for service, there is no evidence from these analyses that the quality of care of moderately ill patients with these two common disease was adversely affected. These findings must be viewed in light of the historically higher costs of fee-for-service medicine and of subspecialty physician practice.

Analysis of Variance↗

PubMed1999

No exit? The effect of health status on dissatisfaction and disenrollment from health plans.

OBJECTIVE: To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE: A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed competition, with substantial enrollment in four types of health plans: fee-for-service, prepaid group practice, independent practice associations, and point-of-service plans. STUDY DESIGN: A set of logistic regression models are estimated to determine the probability of disenrollment, if dissatisfied, controlling for the influence on satisfaction and disenrollment of age, race, education, family income and size, gender, marital status, mental health status, pregnancy, duration of employment and enrollment in the plan, number of alternative plans, and HMO penetration in the local market. Separate coefficients are estimated for enrollees with and without significant physical health problems. Additional models are estimated to test for the influence of selection effects as well as alternative measures of dissatisfaction and health problems. DATA COLLECTION: Data were collected through a mailed survey with a response rate of 63.5 percent; comparisons to a subsample administered by telephone showed few differences. PRINCIPAL FINDINGS: In group/staff model HMOs and point-of-service plans, only 12-17 percent of the chronically ill enrollees who were so dissatisfied when surveyed that they intended to disenroll actually left their plan in the next open enrollment period. This compared to 25-29 percent of the healthy enrollees in these same plans, who reported this level of dissatisfaction and 58-63 percent of the enrollees under fee-for-service insurance. CONCLUSIONS: Switching plans appears to be significantly limited for enrollees with serious health problems, the very enrollees who will be best informed about the ability of their health plan to provide adequate medical care. These effects are most pronounced in plans that have exclusive contracts with providers. We conclude that disenrollment provides only weak safeguards on quality for the sickest enrollees and that reported levels of dissatisfaction and disenrollment represent inaccurate signals of plan performance.

Adult↗

PubMedDate not supplied

Chronic illness and plan satisfaction under managed care.

This DataWatch uses data from the 1993 Employee Health Care Value Survey (EHCVS) to compare the experiences of respondents with and without chronic illnesses under managed care. After controlling for potential confounders, we found that chronic illness was associated with increased odds of dissatisfaction in both independent practice association plans and prepaid group practices, but not under fee-for-service coverage. Chronic illness appeared to exacerbate difficulties and to attenuate the benefits experienced by healthy persons under managed care. We conclude that persons with chronic illnesses may be at particular risk under managed care; their experiences may warrant particular attention when health plan performance is being monitored.

Adult↗

PubMedDate not supplied

Primary care physicians' satisfaction with quality of care in California capitated medical groups.

CONTEXT: Managed care and capitation have placed new responsibilities on primary care physicians, including formally acting as "gatekeepers" for specialty services and tests. Previous studies have not examined whether primary care physicians who provide services to patients under many coverage arrangements feel differently about caring for patients covered under capitation vs those covered through more traditional forms of insurance. An understanding of whether California primary care physicians feel that they deliver a different level of quality to capitated patients could help signal whether variations in care for patients with different coverage forms are evolving. OBJECTIVE: To evaluate whether primary care physicians in California capitated groups report different satisfaction levels with quality of care for patients in their overall practice than for patients covered by capitated contracts and to examine whether physicians' satisfaction with capitated care quality is influenced by the characteristics of the practice setting. DESIGN: Cross-sectional questionnaire. SETTING: A total of 89 California physician groups with capitated contracts. PARTICIPANTS: A total of 910 primary care physicians (80% response rate). MAIN OUTCOME MEASURE: Satisfaction with 4 aspects of quality of care provided to patients covered by capitated contracts vs patients overall. RESULTS: Physicians reported lower satisfaction with all 4 aspects of care for patients covered by capitated contracts than for patients in their overall practice: 71% were very or somewhat satisfied with relationships with capitated patients (compared with 88% for overall practice), 64% were very or somewhat satisfied with the quality of care they provided to capitated patients (compared with 88% for overall practice), 51% were very or somewhat satisfied with their ability to treat capitated patients according to their own best judgment (compared with 79% for overall practice), and 50% were very or somewhat satisfied with their ability to obtain specialty referrals (compared with 59% for overall practice) (P< or =.001 for all comparisons). Being in a medical group practice (vs an independent practice association) and having a larger percentage of capitated patients were independently associated by multivariate analysis with higher levels of satisfaction with capitated quality of care (P< or =.005). CONCLUSION: These California primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than with the quality of care they deliver to patients covered by other payment sources. However, those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated care. National expansion of capitation should be accompanied by efforts to ensure that the satisfaction of practicing physicians with the care they deliver does not decline.

Attitude of Health Personnel↗

PubMed1989

Physician productivity: trends and determinants.

Projections of a physician surplus for the 1990s have assumed that physician productivity will be constant at 1970s levels. Using the HCFA-NORC physician surveys of 1975, 1979, and 1984-85, this study examines trends in physician productivity over the past decade and estimates the impacts of physician and practice characteristics on current productivity. Visit productivity declined significantly between 1975 and 1984, suggesting that the projected surplus may be overstated. Cross-sectional results show that participation in alternative health plans is not associated with greater productivity, except for the higher work effort of independent practice association participants. The effects of physician time, nonphysician aides, and physician gender on productivity vary with alternative visit and revenues measures of productivity.

Cross-Sectional Studies↗

PubMedDate not supplied

Redesigning clinical office practices to improve performance levels in an individual practice association model HMO.

Independent Health, a large health maintenance organization in western New York, is participating in a national initiative to redesign the way healthcare is delivered in the clinical office setting. The Idealized Design of Clinical Office Practices (IDCOP) project aims to initiate profound change in the ways physicians deliver care and treatment in the office; the focus is on demonstrating improvements in access to care, patient care, patient and staff satisfaction, and financial performance. Two clinical prototype test sites have successfully implemented an "open access policy," which enables most patients to see their physician on the day an appointment is requested. The two test sites also found improved clinical indicators (for diabetes and coronary heart disease) that positively affected the health of patients; reduced waiting time, enriching the overall experience of the office visit; and improved patient and staff satisfaction with the operational and care delivery modifications. This article describes the findings of the IDCOP initiative at Independent Health.

Financial Management↗

PubMedDate not supplied

Provider group characteristics & quality report card performance: a cross-sectional study in a managed care setting.

We describe 1 health plan's annual, incentive-based, provider group quality report card (Scorecard) and identify trends in Scorecard performance among 142 California provider groups. We explore variation in Scorecard performance by provider group characteristics. Scorecard evaluates provider groups on standardized measures of performance including preventive screening, patient satisfaction, and quality management operations and infrastructure. In a cross-sectional study, we use linear regression to measure associations between provider group characteristics and performance on the 1997 Scorecard. Provider group performance trends (1996-1997) revealed improvement on 6 Scorecard indicators. Regional differences in performance were also shown. Multivariate results indicate that group location in northern California (P = .01), IPA (independent practice association) status (P = .02), older group age (P = .02), and higher mean patient age (P < .01) were independently associated with higher 1997 Scorecard total scores. Member education was marginally associated with performance. Group size, member income, and gender distributions were not independently associated with Scorecard performance. Results of this study suggest that (among Blue Cross of California's contracted provider groups) older, more established groups; groups located in northern California; IPAs; and groups with a patient demographic mix characterized by higher than network average mean age and a lower than network average proportion of members with a college education or greater were more likely to perform well on Scorecard.

Adult↗

PubMed2004

The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations.

BACKGROUND: Clinical preventive services improve patient health, and reminder systems can increase the use of such services. However, physician organizations often underutilize clinical preventive service reminders. Little is known about the incentives, capabilities, and organizational characteristics associated with the use of reminders by physician organizations. METHODS: The predictors of patient and physician reminder system use were examined in a sample of 1,104 US physician organizations. The cross-sectional sample was obtained through a telephone survey with a 70% response rate. RESULTS: Fifty-one percent of physician organizations used mammogram reminders, 41% used influenza immunization reminders, and 26% used eye exam reminders for patients. Eighteen percent of physician organizations used computer-generated reminders to physicians. Required reporting of data (P = 0.0006), public recognition for quality (P = 0.0002), and IT capabilities (P < 0.0001) were strongly associated with patient reminder use. Medical groups were more likely to use patient-level reminders than independent practice associations (IPAs) (P < 0.0001). Physician reminder use was related to required reporting of data (P < 0.0001) and IT capabilities (P < 0.0001). CONCLUSIONS: Physician organizations have relatively low use of preventive service reminders to patients and physicians. Offering quality incentives to physician organizations and improving their IT capabilities may increase the use of preventive service reminders and improve the delivery of preventive care.

Adult↗

PubMed2004

The relationship of managed care to business, professional, and organizational aspects of radiology practices.

OBJECTIVE: We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices. MATERIALS AND METHODS: A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care. RESULTS: Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement. CONCLUSION: Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

Attitude of Health Personnel↗

PubMed1993

Characteristics of primary care office systems as predictors of mammography utilization.

OBJECTIVE: To evaluate the association between primary care office systems and mammography utilization by women older than 50 years. DESIGN: Cross-sectional. SETTING: An independent-practice association health maintenance organization (HMO) in Massachusetts. PARTICIPANTS: One hundred thirty-two primary care practices, representing 321 physicians and 4378 women with at least 12 months of recent, continuous assignment to a practice participating in the HMO. MEASUREMENTS: Practice characteristics and procedures for mammography referral and follow-up were ascertained by interviews of office managers. For each practice, the proportion of women older than 50 years who received a mammogram during their most recent 12-month period of assignment to the practice was calculated. MAIN RESULTS: Forty-five percent of eligible women received a mammogram during their most recent year of assignment to an HMO practice. In a regression model, use of one particular urban mammography center, group practice, and low percentage of Medicaid patients in the practice were each associated with 9% to 12% higher mammography utilization; use of flowsheets and the scheduling of mammograms by the patients themselves were associated with 7% to 9% higher utilization. Smaller, nonsignificant increases were associated with the use of reminders to patients (5%) and the presence of only internists on staff (5%). The model accounted for 51% of the variation in mammography utilization among practices. CONCLUSIONS: Mammography utilization among women older than 50 years, in a population in which cost was not a barrier, was related to specific office characteristics. Features of the mammography center, the process for scheduling mammograms, the use of flowsheets to prompt physicians, and the use of reminders to patients are important.

Aged↗

PubMed1996

Self-regulation: the true key to success of physician-directed networks.

The purpose of regulation is to promote uniformly high quality health care at a reasonable cost. The purpose of self-regulation is to make regulation more acceptable to the network physicians and create an atmosphere of continual improvement in bedside care. Interviews with medical directors of group practices, independent physician associations, managed care plans, national specialty networks, and physician-hospital organizations were used to learn what methods of self-regulation are popular and effective.

Academic Medical Centers↗

PubMed1989

Vision care benefits and optometric services in HMOs.

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.

Health Maintenance Organizations↗

PubMed1984

Use of ambulatory care services in three provider plans: interactions between patient characteristics and plans.

A previous study of low-income enrollees in a closed-panel health maintenance organization (HMO) and a Blue Cross/Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enrollees. A third plan, an experimental independent practice association (IPA), was also available for analysis. Utilization was defined as use (yes/no) and the quantity of use for those who used services (in standardized dollars). Significant interactions were detected between plan and all of the independent variables but race. The use of services in the HMO was least affected by enrollees' characteristics (age, sex, race, health status, prior use, family size) and use was most sensitive to patient characteristics in BC. In some respects, the IPA was more like the HMO and in other respects more like the BC/BS plan.

Adolescent↗

PubMedDate not supplied

External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

CONTEXT: Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. OBJECTIVES: To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). DESIGN, SETTING, AND PARTICIPANTS: One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. MAIN OUTCOME MEASURES: Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. RESULTS: Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. CONCLUSIONS: The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.

Asthma↗

PubMed1999

Preventive care in Canterbury general practice.

AIMS: To describe the preventive care attitudes, beliefs, priorities and systems of Canterbury general practitioners, to compare their beliefs about appropriate care with evidence-based guidelines and to investigate possible associations between preventive care beliefs and attitudes, and selected practitioner variables. METHOD: A questionnaire was mailed to all 375 general practitioners in Canterbury, with a response rate of 70%. RESULTS: Respondents expressed positive attitudes to preventive care, their views about appropriate care corresponding well to United States Preventive Services Task Force recommendations. The responses of practitioners who had qualified more recently were closer to the recommendations, with these practitioners more likely to want to carry out more preventive care. Membership of an independent practice association or the Royal New Zealand College of General Practitioners was associated with more positive attitudes to preventive care and with believing more interventions to be appropriate. Relatively few preventive interventions appeared to be offered to patients in a systematic way. CONCLUSIONS: Canterbury general practitioners were well-informed about, and interested in carrying out, more preventive care. Preventive care delivery could be enhanced in many practices by the adoption of a more systematic approach.

Attitude of Health Personnel↗

PubMed2004

Managed care organization and the quality of diabetes care: the Translating Research Into Action for Diabetes (TRIAD) study.

OBJECTIVE: To examine the association between the organizational model and diabetes processes of care. RESEARCH DESIGN AND METHODS: We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA(1c) testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language. RESULTS: Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P < 0.0001), and group/network models generally increased the probability of receiving a process by >or=10 percentage points. Among nonprofit plans, no effect of model type was found. CONCLUSIONS: Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.

Diabetes Mellitus↗

PubMed2005

Improved care and outcomes among elderly medicare managed care beneficiaries with diabetes.

OBJECTIVE: To examine individual- and plan-level factors related to improved diabetes care and outcomes between 1999 and 2001 among elderly Medicare managed care beneficiaries with diabetes. STUDY DESIGN: Retrospective analysis of Medicare and individual-level Health Plan and Employer Data Information Set data. METHODS: We merged Medicare demographic information with person-level data regarding 6 comprehensive diabetes care measures provided by the National Committee on Quality Assurance for Medicare managed care enrollees for 1999. Then we identified those beneficiaries for whom comprehensive diabetes care information was also reported in 2001, and determined the improvement for each measure. Data on persons not meeting the comprehensive diabetes care criteria in 1999 were analyzed to determine the factors associated with appropriate care and outcomes in 2001. RESULTS: Of the 174 combinations of individual- or plan-level factors and comprehensive diabetes care measures, 167 showed significant improvements. Nonetheless, for most of the 6 comprehensive diabetes care measures, poor care occurred more frequently for black patients than for white patients, among individuals in for-profit versus not for profit plans, and among individuals in independent practice association plans compared with group and staff model plans. Among the beneficiaries whose healthcare failed to meet the comprehensive diabetes care guidelines in 1999, by 2001, care guidelines were met in approximately three fourths for hemoglobin A1c and low-density lipoprotein cholesterol testing, but in only one half for eye examinations, low-density lipoprotein cholesterol control, and nephropathy monitoring. CONCLUSIONS: Between 1999 and 2001, care of elderly Medicare patients with diabetes improved, including among individuals who previously had not received appropriate care. However, more improvement is needed to achieve equality among members of all race groups and plan types.

Aged↗