Table 1

Practice Characteristics of CPC+ Applicants and Nonapplicants in CPC+ Regions, Before CPC+

CharacteristicAll Practices (n = 16,883)aAmong All Practices in CPC+ Regions P Value
Applicants (n = 4,346)bNonapplicants (n = 12,537)
Practice size and ownership at baselinec
Total no. of practitioners (any specialty), median (IQR)2.0 (1.0-4.0)3.0 (2.0-6.0)2.0 (1.0-3.0)<.001
No. of primary care practitioners, median (IQR)2.0 (1.0-3.0)3.0 (2.0-5.0)1.0 (1.0-3.0)<.001
Practice size
 Large (> 6 primary care practitioners), % (95% CI)12.0 (11.5-12.5)23.2 (22.0-24.5)8.1 (7.6-8.6)<.001
 Medium (3-5 primary care practitioners), % (95% CI)24.6 (23.9-25.2)36.2 (34.8-37.6)20.5 (19.8-21.2)<.001
 Small (1-2 primary care practitioners), % (95% CI)63.4 (62.7-64.2)40.5 (39.1-42.0)71.4 (70.6-72.2)<.001
No. of attributed Medicare FFS beneficiaries at baseline, median (IQR)204 (82-412)410 (231-740)155 (55-311)<.001
No. of attributed Medicare FFS beneficiaries at baseline per PCP, median (IQR)113 (48-194)144 (89-214)99 (32-183)<.001
Owned by a health system or hospital, % (95% CI)d31.6 (30.9-32.3)50.9 (49.5-52.4)24.9 (24.2-25.7)<.001
Owned or managed by a health system, % (95% CI)27.2 (26.5-27.8)46.4 (44.9-47.8)20.5 (19.8-21.2)<.001
Owned by a hospital, % (95% CI)17.4 (16.8-18.0)25.4 (24.1-26.7)14.7 (14.0-15.3)<.001
Practices with selected transformation experience
PCMH recognition, % (95% CI)e23.8 (23.1-24.4)47.5 (46.0-49.0)15.5 (14.9-16.2)<.001
Participant in a Medicare SSP ACO as of January 1 of the first intervention year, % (95% CI)31.0 (30.3-31.7)47.0 (45.6-48.5)25.4 (24.6-26.2)<.001
Participant in CMMI’s TCPI, % (95% CI)7.6 (7.2-8.0)10.5 (9.6-11.4)6.6 (6.2-7.1)<.001
Participant in CMMI’s MAPCP, % (95% CI)f2.5 (2.3-2.7)5.6 (4.9-6.3)1.4 (1.2-1.7)<.001
Participant in CPC Classic, % (95% CI)g2.6 (2.3-2.8)9.9 (9.1-10.8)0 (0-0)<.001
Primary care transformation experience (PCMH recognitione, MAPCPf, or CPC Classicg), % (95% CI)25.8 (25.2-26.5)53.6 (52.1-55.1)16.2 (15.6-16.8)<.001
Primary care transformation experience or TCPI, % (95% CI)31.3 (30.6-32.0)59.4 (58.0-60.9)21.6 (20.8-22.3)<.001
Primary care transformation experience or TCPI or SSP as of January 1 of the first intervention year, % (95% CI)50.5 (49.8-51.3)81.1 (79.9-82.3)39.9 (39.1-40.8)<.001
Practices with ≥ 1 practitioner attesting to meaningful use of EHRs, % (95% CI)h57.7 (57.0-58.4)85.8 (84.7-86.8)48.0 (47.1-48.9)<.001
Characteristics of practice county
Household income in county in which practice is located ($), median (IQR)i51,475 (43,338-62,867)53,164 (45,698-64,916)50,453 (42,896-62,861)<.001
Rural location, % (95% CI)j12.9 (12.4-13.4)8.6 (7.7-9.4)14.4 (13.8-15.0)<.001
Suburban location, % (95% CI)j14.5 (14.0-15.0)14.8 (13.8-15.9)14.4 (13.8-15.0).469
Urban location, % (95% CI)j72.6 (71.9-73.2)76.6 (75.3-77.9)71.2 (70.472.0)<.001
  • AAAHC = Accreditation Association for Ambulatory Health Care; ACO = Accountable Care Organization; CMMI = Center for Medicare and Medicaid Innovation; CMS = Centers for Medicare and Medicaid Services; CPC = Comprehensive Primary Care; CPC+ = Comprehensive Primary Care Plus; EHR = electronic health record; FFS = fee for service; IQR = interquartile range; MAPCP = Multi-Payer Advanced Primary Care Practice; NCQA = National Committee for Quality Assurance; PCMH = patient-centered medical home; PCP = primary care practitioner; SSP = Shared Savings Program; TCPI = Transforming Clinical Practice Initiative; TJC = The Joint Commission; URAC = Utilization Review Accreditation Commission.

  • Note: Table presents the unweighted mean value for each characteristic. Primary care practices include all practices with ≥1 practitioner (defined as a physician, nurse practitioner, or physician assistant) with a specialty of primary care (defined as family practice, general practice, geriatrics, or internal medicine). The 2018 starters represent 11% of all practices, 7% of applicants, and 5% of participants.

  • Sources: Mathematica’s analysis of data on practice size and ownership from SK&A data; data on the number and characteristics of attributed Medicare beneficiaries from Medicare Enrollment Database and claims data; data on PCMH recognition from NCQA, TJC, AAAHC, URAC, and state-specific data sources; data on Medicare SSP ACO participation from CMS Master Data Management data; data on participation in CMMI’s TCPI, CMMI’s MAPCP, and CPC Classic from CMS; data on meaningful use of EHRs from CMS Medicare EHR Incentive Program; county data from the Area Resource File.

  • a Table includes 16,883 of the 19,809 primary care practices in the 2017 and 2018 regions because we excluded 2,926 practices (15%) that had no attributed Medicare FFS beneficiaries in the baseline year.

  • b A total of 4,599 practices applied for CPC+. The number of applicants in this table (4,346) is fewer because some applicants could not be identified in the SK&A data, and some applicants had no attributed Medicare FFS beneficiaries at baseline.

  • c The baseline year is 2016 for the 2017 starters and 2017 for the 2018 starters.

  • d In the SK&A data, a practice can be owned (or managed) by a health system and owned by a hospital.

  • e A practice was considered to have PCMH recognition if ≥1 of its primary care practitioners had recognition at some point in 2014-2017 for the 2017 starters and 2015-2018 for the 2018 starters from a state, the AAAHC, TJC, NCQA, or URAC.

  • f We considered a practice to be a MAPCP participant if it participated in any year from 2011-2014, as determined by a file from CMS.

  • g Participants include all those practices that stayed enrolled in CPC Classic for at least the first 5 months.

  • h At least 1 practitioner attested to meaningful use under the Medicare EHR Incentive Program from 2011-2015 for 2017 starters and 2011-2016 for 2018 starters.

  • i Reflects 2014 data for the 2017 starters and 2015 data for the 2018 starters.

  • j The urbanicity of a practice’s county (rural, urban, suburban) is derived from the 2013 (latest year available) rural-urban continuum codes (https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation/) available in the Area Resource Files for both 2017 and 2018 starters.