Medical groups can reduce costs by investing in improved quality of care for patients with diabetes.

A major feature of many new contracts between providers and payers is shared savings programs, in which providers can earn a percentage of the savings if the cost of the care they provide is lower than the projected cost. Unless providers are also held accountable for meeting quality benchmarks, some observers fear that these programs could erode quality of care by rewarding only cost savings. We estimated the effects on Medicare expenditures of improving the quality of care for patients with diabetes. Analyzing 234 practices that provided care for 133,703 diabetic patients, we found a net savings of $51 per patient with diabetes per year for every one-percentage-point increase in a score of the quality of care. Cholesterol testing for all versus none of a practice's patients with diabetes, for example, was associated with a dramatic drop in avoidable hospitalizations. These results show that improving the quality of care for patients with diabetes does save money.

Factors influencing electronic clinical information exchange in small medical group practices.

PURPOSE: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. METHODS: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange with other health care providers and to identify the factors influencing those patterns. FINDINGS: HIE was found to be largely limited to exchanging immunization data through the state health department and exchanging clinical information within owned provider systems. None of the clinics directly exchange clinical information with non-owned clinics or hospitals. CONCLUSIONS: While regional HIE networks may be a laudable goal, progress is slow and significant technical, political, and financial obstacles remain. Limiting factors include data protection concerns, competition among providers, costs, and lack of compatible electronic health record (EHR) systems.

Differences in the cost of health care provided by group practices in Minnesota.

This article reports the findings of a study designed to identify differences in the cost and quality of care provided by medical group practices in Minnesota. Fifty-three practices that provide services to enrollees of employer-based self-insured health plans were included in the study. Costs adjusted for case mix and payment levels were found to vary from $2,400 to nearly $4,700 per member per year. Quality of care had less variance and was not found to be related to cost. The practices that provided high-quality, low-cost care included both relatively small physician-owned practices and large, multi-clinic systems that also owned hospitals.

Is patient satisfaction influenced by the intensity of medical resource use by their physicians?

OBJECTIVE: To determine whether patients' satisfaction with their primary care is related to providers' use of medical resources. STUDY DESIGN: Sixty-two practices serving 2805 patients enrolled in BlueCross BlueShield of Minnesota were analyzed using hierarchical regression models. METHODS: Three measures of satisfaction included patient satisfaction with overall healthcare, patient satisfaction with the time spent with a physician or other provider during a visit, and the likelihood that a patient would recommend the clinic to others. RESULTS: Patient satisfaction was found to be primarily a function of patient characteristics and not of practice characteristics. Providers' use of medical resources was not significantly related to patients' overall ratings of healthcare or to patients' willingness to recommend the practice to others. However, the time spent with a physician or other provider was significantly negatively related to patient satisfaction. Physician workload was significantly related to patient satisfaction. CONCLUSIONS: To improve patient satisfaction, practices should focus on reducing physician workload. Valid measures of patient satisfaction must correct for the strong effects of patient characteristics.

Factors influencing physician use of clinical electronic information technologies after adoption by their medical group practices.

BACKGROUND: A major factor limiting efficiency and quality gains from clinical information technologies is the lack of full use by the clinicians. PURPOSE: To identify the practice and physician characteristics that influence the use of e-scripts after adoption. METHODS: Data were obtained from 27 primary care medical group practices that had e-script technology for 2 years. Physician and practice characteristics were obtained from the clinics, and the proportion of each physician's prescriptions sent electronically was calculated from the prescription records. Practice culture data were obtained from a survey of the physicians in each practice. Data were analyzed using hierarchal regression. FINDINGS: Practice-level variables explain most of the variance in the use of e-scripts by physicians, although there are significant differences in use among specialties as well. General internists have slightly lower use rates and pediatricians have the highest rates. Larger practices and multispecialty practices have higher use rates, and five practice culture dimensions influence these rates; two have a negative influence and three (organizational trust, adaptive, and a business orientation) have a positive influence. PRACTICE IMPLICATIONS: While previous studies have identified physician characteristics and product deficiencies as factors limiting the use of electronic information technologies in medical practices, our data indicate that the influence of these factors may be highly dependent on the culture of the practice. Consequently, practice administrators can improve physician acceptance and use of these technologies by making sure that there is a culture/technology fit before deciding on a product.

The influence of the structure and culture of medical group practices on prescription drug errors.

BACKGROUND: This project was designed to identify the magnitude of prescription drug errors in medical group practices and to explore the influence of the practice structure and culture on those error rates. Seventy-eight practices serving an upper Midwest managed care (Care Plus) plan during 2001 were included in the study. METHODS: Using Care Plus claims data, prescription drug error rates were calculated at the enrollee level and then were aggregated to the group practice that each enrollee selected to provide and manage their care. Practice structure and culture data were obtained from surveys of the practices. Data were analyzed using multivariate regression. RESULTS: Both the culture and the structure of these group practices appear to influence prescription drug error rates. Seeing more patients per clinic hour, more prescriptions per patient, and being cared for in a rural clinic were all strongly associated with more errors. Conversely, having a case manager program is strongly related to fewer errors in all of our analyses. The culture of the practices clearly influences error rates, but the findings are mixed. Practices with cohesive cultures have lower error rates but, contrary to our hypothesis, cultures that value physician autonomy and individuality also have lower error rates than those with a more organizational orientation. Our study supports the contention that there are a substantial number of prescription drug errors in the ambulatory care sector. Even by the strictest definition, there were about 13 errors per 100 prescriptions for Care Plus patients in these group practices during 2001. CONCLUSIONS: Our study demonstrates that the structure of medical group practices influences prescription drug error rates. In some cases, this appears to be a direct relationship, such as the effects of having a case manager program on fewer drug errors, but in other cases the effect appears to be indirect through the improvement of drug prescribing practices. An important aspect of this study is that it provides insights into the relationships of the structure and culture of medical group practices and prescription drug errors and provides direction for future research. Research focused on the factors influencing the high error rates in rural areas and how the interaction of practice structural and cultural attributes influence error rates would add important insights into our findings. For medical practice directors, our data show that they should focus on patient care coordination to reduce errors.

A comparison of the performance of hospital- and physician-owned medical group practices.

This study compares the financial and productivity performance of hospital- versus physician-owned medical group practices. Nineteen hospital-owned and twenty-three physician-owned family practices were matched by location (state) and size (full-time equivalent providers). The data were obtained from the 1998 Medical Group Management Association (MGMA) Cost Survey database. The focus of this study is on the "bottom-line" performance of the organizations as well as the production costs of the different type of practices. Analyses of these data consider staffing differences, charge and revenue differentials, productivity factors, and differences in patient volume and procedure volume. When comparing the hospital-owned and physician-owned family practice groups, the statistical analysis of these data suggest that the underlying distinctions are driven by differences in the volume of patients and volume of procedures.