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Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination
- Hoangmai H. Pham, MD, MPH;
- Ann S. O'Malley, MD, MPH;
- Peter B. Bach, MD, MAPP;
- Cynthia Saiontz-Martinez, ScM; and
- Deborah Schrag, MD, MPH
- From the Center for Studying Health System Change, Washington, DC; Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, New York, New York; Social and Scientific Systems, Silver Spring, Maryland; and Dana-Farber Cancer Institute, Boston, Massachusetts.
Abstract
Background: Primary care physicians are expected to coordinate care for their patients.
Objective: To assess the number of physician peers providing care to the Medicare patients of a primary care physician.
Design: Cross-sectional analysis of claims data.
Setting: Fee-for-service Medicare in 2005.
Participants: 2284 primary care physicians who responded to the 2004 to 2005 Community Tracking Study Physician Survey.
Measurements: Primary patients for each physician were defined as beneficiaries for whom the physician billed for more evaluation and management visits than any other physician in 2005. The number of physician peers for each physician was the sum of other unique physicians that the index physician's primary patients visited plus other unique physicians who served as the primary physician for each of the index physician's nonprimary patients during 2005.
Results: The typical primary care physician has 229 (interquartile range, 125 to 340) other physicians working in 117 (interquartile range, 66 to 175) practices with which care must be coordinated, equivalent to an additional 99 physicians and 53 practices for every 100 Medicare beneficiaries managed by the primary care physician. When only the 31% of a primary care physician's primary patients who had 4 or more chronic conditions was considered, the median number of peers involved was still substantial (86 physicians in 36 practices). The number of peers varied with geographic region, practice type, and reliance on Medicaid revenues.
Limitations: Estimates are based only on fee-for-service Medicare patients and physician peers, and the number of peers is therefore probably an underestimate. The modest response rate of the Community Tracking Study Physician Survey may bias results in unpredictable directions.
Conclusion: In caring for his or her own primary and nonprimary patients during a single year, each primary care physician potentially must coordinate with a large number of individual physician colleagues who also provide care to these patients.
Funding: National Institute on Aging, American Medical Group Association, and the Robert Wood Johnson Foundation.
Article and Author Information
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Grant Support: By the National Institute on Aging (grant R01 AG025687-01A1), American Medical Group Association, and Robert Wood Johnson Foundation.
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Potential Financial Conflicts of Interest: Grants received: P.B. Bach (National Institute on Aging).
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Reproducible Research Statement: Study protocol: Available from Dr. Pham (e-mail, mpham{at}hschange.org). Statistical code and data set: Not available.
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Requests for Single Reprints: Hoangmai Pham, MD, MPH, Center for Studying Health System Change, 600 Maryland Avenue SW, Suite 550, Washington, DC 20024; e-mail, mpham{at}hschange.org.
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Current Author Addresses: Drs. Pham and O'Malley: Center for Studying Health System Change, 600 Maryland Avenue SW, Suite 500, Washington, DC 20024.
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Dr. Bach: Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York NY 10021.
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Ms. Saiontz-Martinez: Social and Scientific Systems, 8757 Georgia Avenue, 12th Floor, Silver Spring, MD 20910.
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Dr. Schrag: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.
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Author Contributions: Conception and design: H.H. Pham, A.S. O'Malley, P.B. Bach, D. Schrag.
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Analysis and interpretation of the data: H.H. Pham, A.S. O'Malley, P.B. Bach, D. Schrag.
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Drafting of the article: H.H. Pham, P.B. Bach, D. Schrag.
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Critical revision of the article for important intellectual content: H.H. Pham, A.S. O'Malley, P.B. Bach, D. Schrag.
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Final approval of the article: H.H. Pham, A.S. O'Malley, P.B. Bach, D. Schrag.
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Provision of study materials or patients: H.H. Pham.
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Statistical expertise: P.B. Bach, D. Schrag.
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Obtaining of funding: H.H. Pham, P.B. Bach.
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Administrative, technical, or logistic support: H.H. Pham.
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Collection and assembly of data: H.H. Pham, P.B. Bach.
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