Table 3.
Practice Characteristics of CPC+ Participants and Nonparticipants Among CPC+ Applicants, Before CPC+
| Characteristic | Applicants (n = 4,346)a | Among Applicants
|
P Value | |
|---|---|---|---|---|
| Participants (n = 3,051)b,c | Nonparticipants (n = 1,295) | |||
| Practice size and ownership at baseline d | ||||
| Total no. of practitioners (any specialty), median (IQR) | 3.0 (2.0-6.0) | 4.0 (2.0-6.0) | 3.0 (2.0-5.0) | <.001 |
| No. of primary care practitioners, median (IQR) | 3.0 (2.0-5.0) | 3.0 (2.0-6.0) | 2.0 (1.0-4.0) | <.001 |
| Practice size | ||||
| Large (> 6 primary care practitioners), % (95% CI) | 23.3 (22.0-24.5) | 26.6 (25.0-28.2) | 15.4 (13.4-17.3) | <.001 |
| Medium (3-5 primary care practitioners), % (95% CI) | 36.2 (34.8-37.6) | 37.1 (35.4-38.9) | 34.1 (31.5-36.6) | .052 |
| Small (1-2 primary care practitioners), % (95% CI) | 40.5 (39.1-42.0) | 36.3 (34.5-38.0) | 50.6 (47.9-53.3) | <.001 |
| No. of attributed Medicare FFS beneficiaries at baseline, median (IQR) | 410 (231-740) | 484 (288-837) | 253 (117-497) | <.001 |
| No. of attributed Medicare FFS beneficiaries at baseline per PCP, median (IQR) | 144 (89-214) | 159 (107-232) | 107 (61-173) | <.001 |
| Owned by a health system or hospital, % (95% CI)e | 50.9 (49.5-52.4) | 54.0 (52.2-55.8) | 43.7 (41.0-46.4) | <.001 |
| Owned or managed by a health system, % (95% CI) | 46.4 (44.9-47.8) | 49.3 (47.5-51.0) | 39.5 (36.9-42.2) | <.001 |
| Owned by a hospital, % (95% CI) | 25.4 (24.1-26.7) | 27.6 (26.0-29.2) | 20.2 (18.0-22.4) | <.001 |
| Practices with selected transformation experience | ||||
| PCMH recognition, % (95% CI)f | 47.5 (46.0-49.0) | 52.6 (50.8-54.3) | 35.4 (32.8-38.1) | <.001 |
| Participant in a Medicare SSP ACO as of January 1 of the first intervention year, % (95% CI) | 47.0 (45.6-48.5) | 46.2 (44.5-48.0) | 49.0 (46.2-51.7) | .104 |
| Participant in CMMI’s TCPI, % (95% CI) | 10.5 (9.6-11.4) | 10.8 (9.7-11.9) | 9.7 (8.1-11.3) | .276 |
| Participant in CMMI’s MAPCP, % (95% CI)g | 5.6 (4.9-6.3) | 6.9 (6.0-7.7) | 2.5 (1.7-3.4) | <.001 |
| Participant in CPC Classic, % (95% CI)h | 9.9 (9.1-10.8) | 14.1 (12.8-15.3) | 0.2 (0-0.5) | <.001 |
| Primary care transformation experience (PCMH recognitionf, MAPCPg, or CPC Classich), % (95% CI) | 53.6 (52.1-55.1) | 60.7 (59.0-62.4) | 36.8 (34.2-39.5) | <.001 |
| Primary care transformation experience or TCPI, % (95% CI) | 59.4 (58.0-60.9) | 65.7 (64.1-67.4) | 44.5 (41.8-47.2) | <.001 |
| Primary care transformation experience or TCPI or SSP as of January 1 of the first intervention year, % (95% CI) | 81.1 (79.9-82.3) | 84.6 (83.3-85.9) | 72.9 (70.5-75.3) | <.001 |
| Practices with ≥ 1 practitioner attesting to meaningful use of EHRs, % (95% CI)i | 85.8 (84.7-86.8) | 90.4 (89.3-91.4) | 74.9 (72.5-77.3) | <.001 |
| Characteristics of practice county | ||||
| Household income in county in which practice is located ($), median (IQR)j | 53,164 (45,698-64,916) | 54,089 (46,185-66,315) | 49,503 (44,015-61,170) | <.001 |
| Rural location, % (95% CI)k | 8.6 (7.7-9.4) | 8.7 (7.7-9.7) | 8.3 (6.8-9.8) | .646 |
| Suburban location, % (95% CI)k | 14.8 (13.8-15.9) | 15.4 (14.2-16.7) | 13.4 (11.6-15.3) | .082 |
| Urban location, % (95% CI)k | 76.6 (75.3-77.9) | 75.9 (74.4-77.4) | 78.3 (76.1-80.5) | .08 |
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 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 2018 starters comprise approximately 5% of the participating CPC+ practices and 5% of attributed beneficiaries.
As of April 1 of the first intervention year.
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 remained 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.