Table 1.
Practice Characteristics of CPC+ Applicants and Nonapplicants in CPC+ Regions, Before CPC+
| Characteristic | All Practices (n = 16,883)a | Among All Practices in CPC+ Regions
|
P Value | |
|---|---|---|---|---|
| Applicants (n = 4,346)b | Nonapplicants (n = 12,537) | |||
| Practice size and ownership at baseline c | ||||
| 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)d | 31.6 (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)e | 23.8 (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)f | 2.5 (2.3-2.7) | 5.6 (4.9-6.3) | 1.4 (1.2-1.7) | <.001 |
| Participant in CPC Classic, % (95% CI)g | 2.6 (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)h | 57.7 (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)i | 51,475 (43,338-62,867) | 53,164 (45,698-64,916) | 50,453 (42,896-62,861) | <.001 |
| Rural location, % (95% CI)j | 12.9 (12.4-13.4) | 8.6 (7.7-9.4) | 14.4 (13.8-15.0) | <.001 |
| Suburban location, % (95% CI)j | 14.5 (14.0-15.0) | 14.8 (13.8-15.9) | 14.4 (13.8-15.0) | .469 |
| Urban location, % (95% CI)j | 72.6 (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.
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.
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.
The baseline year is 2016 for the 2017 starters and 2017 for the 2018 starters.
In the SK&A data, a practice can be owned (or managed) by a health system and owned by a hospital.
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.
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.
Participants include all those practices that stayed enrolled in CPC Classic for at least the first 5 months.
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.
Reflects 2014 data for the 2017 starters and 2015 data for the 2018 starters.
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.