Table 1. Descriptive Statistics of 2061 Physician Practices by Participation in APMsa,b.
| Variable | Alternative payment models, % (SE)c | P valued | |||||
|---|---|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | 5 | ||
| Practice characteristics | |||||||
| No. of practices | 185 | 285 | 438 | 529 | 387 | 237 | |
| System type e,f | |||||||
| Independent | 56.8 (5.5) | 51.3 (4.9) | 47.8 (3.9) | 38.7 (3.5) | 26.6 (3.8) | 16.3 (4.1) | <.001 |
| Medical group | 7.5 (2.1) | 9.4 (1.9) | 12.7 (2.0) | 15.5 (2.0) | 19.9 (2.7) | 20.9 (3.3) | <.001 |
| Simple system | 9.4 (2.3) | 9.1 (1.8) | 13.0 (1.9) | 12.3 (2.0) | 11.3 (2.0) | 11.9 (2.6) | .59 |
| Complex system | 26.3 (4.9) | 30.2 (4.6) | 26.5 (3.4) | 33.5 (3.5) | 42.2 (4.3) | 50.9 (5.1) | <.001 |
| Physician practice's health system includes an academic medical centerf | 20.3 (4.5) | 22.4 (4.3) | 22.7 (3.3) | 25.8 (3.6) | 32.8 (4.3) | 37.6 (5.1) | .03 |
| Practice sizef | |||||||
| Small (<10 physicians) | 84.1 (3.5) | 79.8 (3.3) | 77.1 (3.3) | 77.1 (2.4) | 70.9 (3.2) | 67.9 (3.7) | .01 |
| Medium (10-20 physicians) | 8.4 (2.4) | 8.7 (2.0) | 10.8 (2.9) | 13.0 (2.0) | 12.7 (2.2) | 13.7 (2.5) | .40 |
| Large (>20 physicians) | 7.4 (2.7) | 11.6 (2.7) | 12.1 (2.2) | 9.9 (1.5) | 16.4 (2.4) | 18.4 (3.1) | .02 |
| Mean proportion of primary care physicians | 64.2 (2.5) | 62.5 (2.9) | 65.8 (1.8) | 66.4 (1.7) | 62.9 (1.9) | 65.8 (2.0) | .66 |
| Mean % of practice's annual patient care revenue sourceg | |||||||
| Commercial health insurance | 41.0 (2.5) | 37.7 (2.3) | 38.9 (1.5) | 41.6 (1.3) | 41.3 (1.6) | 42.5 (2.0) | .44 |
| Medicare | 33.3 (2.1) | 31.4 (2.2) | 33.0 (1.4) | 32.0 (1.1) | 31.3 (1.3) | 29.8 (1.5) | .61 |
| Medicaid | 13.2 (1.9) | 18.1 (2.3) | 16.4 (1.4) | 16.1 (1.2) | 18.8 (1.5) | 18.2 (1.8) | .23 |
| Self-pay | 7.2 (1.2) | 9.6 (2.2) | 6.7 (0.8) | 6.1 (0.4) | 5.0 (0.4) | 6.1 (1.0) | .06 |
| Other | 5.3 (1.8) | 3.1 (0.4) | 5.0 (1.0) | 4.2 (0.5) | 3.6 (0.4) | 3.4 (0.4) | .31 |
| Intense market competition for patients in the outpatient settingf | 71.4 (4.7) | 66.6 (4.0) | 74.6 (2.8) | 71.9 (2.7) | 75.4 (3.1) | 74.7 (3.7) | .54 |
| Integration variableh | |||||||
| Composite index | |||||||
| Clinical | 0.49 (0.02) | 0.52 (0.02) | 0.55 (0.01) | 0.59 (0.01) | 0.65 (0.1) | 0.67 (0.1) | <.001 |
| Functional | 0.48 (0.03) | 0.54 (0.02) | 0.55 (0.02) | 0.59 (0.01) | 0.61 (0.1) | 0.66 (0.2) | <.001 |
| Cultural | 0.64 (0.02) | 0.64 (0.02) | 0.63 (0.01) | 0.63 (0.01) | 0.64 (0.1) | 0.64 (0.2) | .96 |
| Financial: systemwide financial planning and revenue sharing f,i | 52.0 (6.1) | 44.6 (5.5) | 45.5 (4.3) | 44.4 (3.4) | 48.7 (3.7) | 51.4 (5.0) | .76 |
| Geographyj | |||||||
| Urbanicityf | |||||||
| Urban | 75.3 (5.2) | 80.8 (3.2) | 81.0 (3.2) | 86.2 (2.2) | 85.5 (2.8) | 86.2 (3.0) | .27 |
| Suburban | 18.4 (5.2) | 9.6 (2.4) | 11.3 (3.0) | 7.6 (1.8) | 8.5 (2.2) | 6.3 (2.2) | .29 |
| Rural | 6.2 (1.9) | 9.6 (2.4) | 7.7 (1.8) | 86.2 (2.2) | 6.0 (1.7) | 7.5 (2.2) | .82 |
| Regionf | |||||||
| Northeast | 11.7 (3.2) | 17.4 (3.4) | 16.2 (2.6) | 29.6 (3.2) | 21.6 (3.2) | 31.8 (5.0) | <.001 |
| Midwest | 24.6 (4.5) | 27.9 (4.0) | 27.7 (3.4) | 20.1 (2.5) | 27.9 (3.6) | 20.7 (3.4) | .10 |
| South | 42.8 (5.5) | 32.9 (4.3) | 33.3 (3.4) | 23.5 (2.7) | 25.5 (3.4) | 20.2 (3.5) | .002 |
| West | 20.9 (5.1) | 21.9 (4.8) | 22.9 (3.5) | 26.8 (3.3) | 25.0 (3.6) | 27.3 (4.8) | .83 |
Abbreviations: APMs, alternative payment models; NSHOS, National Survey of Healthcare Organizations and Systems.
Alternative payment models included (1) bundled or episode-based payments; (2) Comprehensive Primary Care, Comprehensive Primary Care Plus, and patient-centered medical home; (3) pay-for-performance programs; (4) capitated contracts with commercial health plans; and (5) accountable care organizations (Medicare, Medicaid, and commercial).
All statistics were adjusted for sampling weights.
Standard errors, which were obtained after accounting for the survey nature of the data in estimating means of each covariate, are reported in lieu of SDs.
P values are reported for testing linear hypotheses for differences in means or proportions across number of alternative payment model categories.
Medical group contains physician practices but no hospitals, simple system contains practices and hospitals but no owner subsidiary, and complex system contains practices and hospitals and at least 1 owner subsidiary.
Take the value of 1 if yes, and 0 otherwise.
Total of 1669.
Each integration measure composite index (0, 1) is a simple weighted sum of components with equal weight allocated to each component.
Only practices operating within a larger organization were asked about financial planning and revenue sharing (n = 1413).
Urban, suburban, and rural areas were defined based on rural-urban commuting area classifications. Urban areas include metropolitan area (core, high commuting, and low commuting). Suburban areas include micropolitan areas (core, high commuting, and low commuting). Rural areas include small towns (core, high commuting, and low commuting), rural areas, and zip code tabulation areas not coded.