Large, multispecialty group practices provide higher quality care at lower annual cost

It has been theorized that large, multispecialty group practices provide higher-quality care at lower costs than small group practices.

A study in Health Affairs examined this theory, comparing the costs and quality of care provided to Medicare patients in twenty-two health care markets by physicians who did and did not work within large multispecialty group practices affiliated with the Council of Accountable Physician Practices (CAPP).

After adjustment for patient factors, in most markets CAPP group physicians provided higher quality care at a 3.6% ($272 per patient) lower annual cost. The authors estimate that if all physicians could perform at this level, Medicare would save about $15 billion a year.

The study did have limitations.  Although a correction for patient characteristics was made, the CAPP groups tended to care for patients who were younger, lived in more affluent neighborhoods, had less complex illnesses, and relied less on Medicaid. These factors could influence the ability of these patients to obtain preventive services.

(Sources: Today’s News from Partners HealthCare, June 2, 2010; Health Affairs, http://content.healthaffairs.org, June 9, 2010)

Comments

[James Pfeffer]

It is no secret that large physician groups tend to have more resources for initiatives that are not directly related to patient care, thus, can spend more on IT (electronic medical records and such). Although there is little evidence tying any expenditure or initiative directly to quality improvement, little by little, we are seeing evidence that more resources begets more quality infrastructure (such as electronic records), and the 'mom and pop' physician practice is being left behind. Some have suggested this is ok...but it does feel a little like losing some unique part of Americana.

I can confirm as a patient this trend. I am kind of an industry 'insider', with ~20 years working in health care, and I know enough about quality to know that bigger is better for many diagnoses and treatments. Having access to physicians who can look at a medical record with prompts with the latest evidence is very strong. Us patients know this to be true since we can find out so much ourselves just looking online prior to an appointment. So I push to receive most of my care from the largest physician group i can since these groups tend to have the most convenience (e.g., appointments, on site drug dispensing, radiology, imaging, services to manage co-occurring and multiple conditions, etc.). With the onset of accountable care and re-organizing of care that is going on in the industry, It is likely that in 20 years few small physician groups will exist. It is inevitable, but it is still sad to see happen...