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The Evolving Landscape of Physician Practice: Health Affairs' March Issue

Bethesda, MD -- The March issue of Health Affairs explores public and private measures for reporting quality data in the health care system. The issue also contains several studies pertaining to value in the health care system, including collection and tracking of quality data, hospital participation in accountable care organizations, prescription drug benefits, and others. 

This month's DataGraphic provides a pictorial view of key facts about the changing landscape of physician practice. 

The March issue of Health Affairs was supported in part by The Physicians Foundation. 

Common physician practice specialties spend $15.4 billion annually to report quality data.
A national survey of physician practices finds physicians and staff spend, on average, 785.2 physician and staff hours per physician annually--equaling $15.4 billion--to track and report quality measures for Medicare, Medicaid, and private health insurers. Lawrence P. Casalino of Weill Cornell Medicine and coauthors analyzed results from a national survey of cardiology, orthopedics, primary care, and multispecialty practices. Surveyed practices reported spending 15.1 hours per physician per week (pictured below) dealing with external quality measures such as developing and implementing data collection processes, entering information relevant for quality reporting into patient medical records, and collecting and transmitting data. The average cost to a practice for spending this time is $40,069 per physician per year. Eighty-one percent of surveyed practices reported that the effort they spend on quality measures is "more" or "much more" compared to three years ago, but only 27 percent believe that the measures moderately or strongly represent their quality of care.

©2016 Health Affairs

Fee-for-service is growing--accounting for nearly 95 percent of all physician office visits.
Despite policy interest in moving away from fee-for-service in favor of risk-based payment models, new research shows that fee-for-service remains the dominant payment method for physician visits and, in fact, continues to grow. Samuel H. Zuvekas and Joel W. Cohen of the Agency for Healthcare Research and Quality examined the prevalence of pure capitation--in which a physician receives a fixed monthly payment per patient regardless of services provided--from 1996 to 2013. They found that the overall percentage of physician office visits covered has slowly declined since 2007. In 2013 capitated payments declined to 5.3 percent of all US physician office visits, with 94.7 percent covered under fee-for-service arrangements.

Researchers dispute the notion that retail clinics ultimately save payers money.
Because they are cheaper than physician office and emergency department (ED) visits, retail clinics have been seen as saving money for patients and health plans. To understand whether the use of retail clinics cuts health care costs, J. Scott Ashwood of RAND and coauthors assessed data from a large health plan to understand what fraction of visits to retail clinics replace office or ED visits versus those that represent new utilization. They found that 58 percent of retail clinic visits represented new utilization--cases in which an individual would not otherwise have sought care elsewhere. Because new utilization outweighed replacement, the overall health spending for low-severity conditions (such as sinusitis and urinary tract infections) and preventive services (such as immunizations) increased by $14 per person per year. The findings refute the notion that retail clinics are a means of saving money.

Primary care practices may not be well equipped to manage depression.
Using data from the National Study of Physician Organizations survey, Tara F. Bishop of Weill Cornell Medicine and coauthors assessed care management use across four chronic conditions: asthma, depression, diabetes, and congestive heart failure. When compared against the overall mean score for care management (4.8), depression scored significantly lower (0.8)--meaning that less than one care management process for depression was used across the practices. The authors say the findings suggest that US primary care practices may not be well equipped to manage depression as a chronic illness, despite the fact that more than half of the 8 million ambulatory care visits for depression each year in the US are to a primary care physician.

Without paid sick leave, workers are more likely to work through illness.
Full- and part-time US workers without paid sick leave are three times more likely to forgo medical care for themselves and 1.6 times more likely to forgo medical care for their family, compared to working adults with paid sick leave benefits. LeaAnne DeRigne of Florida Atlantic University and coauthors used data from the National Health Interview Survey to assess the risks associated with not having paid sick leave. Nearly 49 million workers in the US do not have paid sick leave and are more likely to have fair or poor health. Insured working adults with paid sick leave benefits stay home when sick or injured an average of 1.5 more days annually compared to their counterparts without paid leave. The authors also examined income data, finding that low-income workers without paid sick leave are the least likely to address health care concerns in a timely manner.

Also of interest in the March issue:

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download monthly Narrative Matters podcasts. Tap into Health Affairs content with the iPad app.