Article Figures & Data
Tables
Characteristic Arizona Community Physicians Central Ohio Primary Care Physicians Infinity Primary Care Physicians New West Physicians ProHealth Physicians Location Arizona Ohio Michigan Colorado Connecticut Year started 1994 1996 2004 1994 1997 Physicians, No. 130 255 49 65 242 Physicians as owners, % 91 83 60 81 75 Physicians in primary care,a % 88 69 100 82 95 General internal medicine physicians, % 32 31 33 31 31 Family medicine physicians, % 45 20 67 51 29 Geriatricians, % 0 0 0 0 0 Hospitalists, % 0 22 0 14 0 Pediatricians, % 12 18 0 0 35 Outpatient practice sites, No. 54 53 9 17 90 Other specialties Dermatology, endocrinology, gynecology, pediatrics, rheumatology Allergy, endocrinology, infectious disease, pediatrics, physical medicine and rehabilitation None Cardiology, gastroenterology, psychiatry Gastroenterology, otolaryngology, neurology, pediatrics, plastic surgery Nurse practitioners and physician assistants, No. 36 25 1 27 142 Nurse care managers, No. 1 6 2 6 6 NCQA PCMH sites, No. 44 44 4 17 71 Ancillary services Laboratory
Imaging, including bone density test, CT, MRI, mammography, ultrasoundLaboratory
Imaging, including bone density, CT, MRI, nuclear stress tests, and stress echocardiograms, ultrasound, physical therapyLaboratory
Imaging, including bone density test, CT, nuclear stress tests and stress echocardiogram, ultrasoundLaboratory
Imaging, including bone density test, CMIT, stress echocardiogram, ultrasoundLaboratory
Imaging, including ultrasound, echocardiogram, bone density testAnnual revenue, in millions, $ 95.8 122.0 22.5 52 158.9 Gross revenue from payors Commercial, % 53 62 71 78 68 Traditional Medicare, % 22 20 17 0 13 Traditional Medicaid/SCHIP, % 0.3 3 1 <1 10 Medicare Advantage, % 17 8 6 22 4 Medicaid HMOs, % 4 0 3 0 0 Other, % 4 7 2 0 3 Patients in risk contracts Medicare Shared Savings or Pioneer, No. 26,382b 0 5,044c 0 32,858 Medicare Advantage, No. 20,000 20,000 4,130 13,000 10,500 Medicaid ACO, No. 0 0 0 0 0 Other form of risk for patient care, including ACO-like or pay-for-performance contracts with health insurers, No. 15,000 160,000 37,984 50,000 109,300 Participate in an IPA No No Yes No No Physician compensation Base salary, % 0 0 0 60 0 Productivity, % 100 90 90 20 90 Other,d % 0 10 10 20 10 ACO = accountable care organization; CMIT = carotid intima-media thickness test; CT = computed tomography; HMO = health maintenance organization; IPA = independent practice association; MRI = magnetic resonance imaging; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home; SCHIP = State Children’s Health Insurance Program.
Note: Information for 2014 provided in writing by the 5 medical groups.
↵a Includes family practitioners, general internists, geriatricians, and general pediatricians. Does not include hospitalists.
↵b Through the Commonwealth Primary Care ACO.
↵c Through the Physician Organization of Michigan ACO.
↵d Components include quality, cost control, panel size, patient satisfaction, other.
Characteristic Mean for all Groups (N = 168) Arizona Community Physicians (n = 29) Central Ohio Primary Care Physicians (n = 33) Infinity Primary Care Physicians (n = 37) New West Physicians (n = 39) ProHealth Physicians (n = 30) Response rate, % 67 58 66 74 78 60 Age, y 50.7 55.7 47.4 48.6 48.9 54.0 Sex, female, % 39.5 20.7 51.5 52.8 51.3 13.3 Specialty Family practice, % 58.1 62.1 45.5 75.0 66.7 36.7 Internal medicine, % 38.9 34.5 48.5 22.2 33.3 60.0 Other 3.0 3.4 6.1 2.8 0.0 3.3 Years in the group 10.9 11.9 10.3 10.2 10.8 11.6 Physician as owners, %a 84.2 96.6 97.0 66.7 89.5 72.4 Previous practice setting Solo/small primary care, % 48.8 65.5 39.4 13.5 59.0 73.3 Multispecialty, % 6 20.7 6.1 2.7 0.0 3.3 Hospital based, % 25 13.8 21.2 67.6 7.7 10.0 Academic medical center, % 7.7 6.9 15.2 5.4 5.1 6.7 Community health center/public, % 3.6 6.9 3.0 0.0 5.1 3.3 VA/government, % 0.6 0.0 3.0 0.0 0.0 0.0 Residency or fellowship training, % 21.4 13.8 30.3 13.5 35.9 10.0 Office visits per day, No. 18.8 18.2 18.6 19.0 18.0 20.4 Hours worked per day 10.3 9.8 10.7 10.2 10.0 10.9 VA = Veterans Affairs.
Note: Data from physician survey; see Supplemental Appendix 2 (http://annfammed.org/content/14/1/16/suppl/DC1) for a copy of the survey instrument.
↵a This percentage may differ from the percentage in Table 1. Table 1 gives the percentage reported by group leaders; Table 2 gives the percentage of respondents who reported being owners/shareholders.
Area of Satisfaction All Groups (N = 168) Arizona Community Physicians (n = 29) Central Ohio Primary Care Physicians (n = 33) Infinity Physicians (n = 37) New West Physicians (n = 39) ProHealth Physicians (n = 30) Overall satisfaction Satisfaction with their medical group 4.1 4.5 4.5 3.1 4.6 3.4 Somewhat or very satisfied, mean % 74.3 89.7 87.9 42.9 94.9 53.3 Very satisfied, mean % 48.2 69.0 66.7 11.4 71.8 20.0 Very dissatisfied, mean % 1.2 0.0 0.0 2.9 2.6 0.0 Satisfaction with their career in medicine 4.0 4.4 3.8 3.5 4.2 3.9 Somewhat or very satisfied, mean % 80.8 93.1 78.8 63.9 92.3 75.9 Very satisfied, mean % 38.0 51.7 36.4 25.0 43.6 34.5 Very dissatisfied, mean % 4.2 0.0 6.1 8.3 2.9 3.4 Income and quality of life Satisfied with income 3.8 4.2 3.8 2.9 4.5 3.5 Agree or strongly agree, mean % 69.9 92.6 72.8 32.4 97.4 53.4 Strongly agree, mean % 27.6 29.6 27.3 5.9 53.8 16.7 Strongly disagree, mean % 2.5 0.0 3.0 8.8 0.0 0.0 Satisfied with clinical workload 3.3 3.6 3.5 2.7 3.9 2.9 Agree or strongly agree, mean % 57.5 72.4 60.6 35.3 79.5 36.6 Strongly agree, mean % 13.9 20.7 21.2 26.5 15.4 3.3 Strongly disagree, mean % 7.3 6.9 3.0 17.6 0.0 10.0 Satisfied with work/life balance 3.3 3.5 3.3 2.4 3.8 2.9 Agree or strongly agree, mean % 52.7 65.5 57.6 31.3 74.3 30 Strongly agree, mean % 15.3 20.7 15.2 6.3 25.6 6.7 Strongly disagree, mean % 7.4 6.9 3.0 18.8 0.0 10.0 Intragroup relations and processes Satisfied with ownership in the group 4.2 4.4 4.4 3.8 4.4 4.0 Agree or strongly agree, mean % 85.4 89.7 93.9 72.7 87.2 83.4 Strongly agree, mean % 43.9 55.2 54.5 21.2 66.7 16.7 Strongly disagree, mean % 0.6 0.0 0.0 0.0 2.6 0.0 Satisfied with input into key decisions 3.5 3.8 3.9 2.7 4.2 3.0 Agree or strongly agree, mean % 60.1 67.8 75.7 27.3 84.6 40 Strongly agree, mean % 24.5 32.1 24.2 6.1 48.7 6.7 Strongly disagree, mean % 4.9 0.0 3.0 12.1 0.0 10.0 Group’s quality improvement efforts Group invests in processes that improve the quality of care 4.2 4.1 4.6 3.7 4.8 3.9 Agree or strongly agree, mean % 88.5 93.1 100.0 73.5 97.4 76.6 Strongly agree, mean % 47.9 27.6 69.7 17.6 89.7 23.3 Strongly disagree, mean % 1.8 0.0 0.0 5.9 2.6 0.0 Group’s compensation formula rewards physicians who provide high quality care 3.4 3.2 3.7 2.6 4.2 3.1 Agree or strongly agree, mean % 53 31 69.7 24.3 87.2 43.3 Strongly agree, mean % 20.7 17.2 24.2 6.1 41.0 10.0 Strongly disagree, mean % 5.5 3.4 3.0 12.1 0.0 10.0 Relations with hospitals and specialists Physician ownership offers less pressure from external entities, eg, hospitals 4.1 4.4 4.4 3.7 4.1 4.1 Agree or strongly agree, mean % 82.4 93.1 90.9 67.6 76.9 86.6 Strongly agree, mean % 44.8 51.7 63.6 23.5 51.3 33.3 Strongly disagree, mean % 0.6 0.0 0.0 0.0 2.6 0.0 Satisfied with autonomy in practicing medicine 4.0 4.3 4.2 3.5 4.2 3.6 Agree or strongly agree, mean % 78.6 89.6 84.9 59.4 92.3 63.3 Strongly agree, mean % 34.4 44.8 45.5 28.1 41.0 10.0 Strongly disagree, mean % 1.2 0.0 0.0 6.3 0.0 0.0 Primary care group = more cohesion 3.9 3.9 4.4 3.4 4.4 3.6 Agree or strongly agree, mean % 78.2 79.3 97 55.9 89.7 66.7 Strongly agree, mean % 30.9 20.7 45.5 8.8 56.4 16.7 Strongly disagree, mean % 2.4 0.0 0.0 5.9 2.6 3.3 Easy access to specialty care 4.3 4.1 4.5 4.2 4.5 4.0 Agree or strongly agree, mean % 93.3 93.1 100 88.2 94.8 90 Strongly agree, mean % 41.2 24.9 51.5 38.2 61.5 23.3 Strongly disagree, mean % 0.6 0.0 0.0 0.0 0.0 3.3 Note: Responses were on a scale from 1 to 5, where 1 = strongly disagree and 5 = strongly agree or 1 = very unsatisfied and 5 = very satisfied, as appropriate. See Supplemental Appendix 2 at http://annfammed.org/content/14/1/16/suppl/DC1 for a copy of the survey instrument.
Reason All Groups (N = 168) % Arizona Community Physicians (n = 29) % Central Ohio Primary Care Physicians (n = 33) % Infinity (n = 37) % New West (n = 39) % ProHealth (n = 30) % Greater negotiating leverage with health insurers 45.2 58.6 42.4 21.6 38.5 73.3 Group’s business expertise allows physician to focus on medicine 41.7 58.6 45.5 16.2 53.8 36.7 Potential for higher income 38.1 75.9 33.3 32.4 23.1 33.3 Greater autonomy than in other large organizations 33.3 37.9 45.5 37.8 23.1 23.3 Opportunity to become an owner 25.0 13.8 15.2 43.2 33.3 13.3 Alignment with group values, culture 23.2 3.4 24.2 40.5 23.1 20.0 Prefer primary care to multispecialty group 22.6 10.3 27.3 18.9 30.8 23.3 Better work-life balance 22.6 20.7 27.3 21.6 23.1 20.0 Technological infrastructure (eg, emergency medical response) 8.9 6.9 0.0 10.8 10.3 16.7 Need to relocate geographically 6.0 0.0 3.0 5.4 10.3 10.0 Group’s clinical quality programs 5.4 0.0 0.0 10.8 10.3 3.3 Note: Data from the physician survey conducted for this project. Each physician was asked to choose up to 3 reasons for joining his or her current medical group. Percentages are the percentages of physicians who selected that reason for joining their group. See Supplemental Appendix 2 (http://annfammed.org/content/14/1/16/suppl/DC1) for a copy of the survey instrument.
Additional Files
Supplemental Appendixes 1-2
Files in this Data Supplement:
- Supplemental data: Appendixes - PDF file
The Article in Brief
Large Independent Primary Care Medical Groups
Lawrence P. Casalino , and colleagues
Background In the turbulent U.S. health care environment, physicians are increasingly, choosing to become employed by large organizations, such as large multispecialty or single specialty medical groups. This opportunity is often not available, however, and many physicians are becoming employed by hospitals. For primary care physicians (PCPs), there is another option: the large physician-owned primary care medical group. Few physicians and policy experts are aware of these groups. In this article, the authors describe five large PCP groups and their advantages, disadvantages, and challenges.
What This Study Found Large independent physician-owned primary care groups offer physicians an attractive employment alternative to hospital or large multispecialty medical groups and can also benefit patients and society. 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. The five groups studied had an average size of 148 physicians of whom 87 percent were primary care physicians. 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, are 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.The groups' physicians reported only moderate satisfaction with their clinical workload and work-life balance, suggesting that the groups have not fully resolved the difficulties of practicing primary care medicine.
Implications
- 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.
Correction
The degree of MD was erroneously added to Jayme L. Mendelsohn, MPH in the author listing for: Casalino LP, Chen MA, Staub C, Press MJ, Mendelsohn JL, Lynch JT, Miranda Y. Large Independent Primary Care Medical Groups. Ann Fam Med. 2016;14:16-25. A new PDF will be uploaded and the online version will therefore differ from the print version of the article.