Survey Highlights Changing Primary Care Practice Environment

August 18, 2015 - Primary care providers confirm mixed opinions regarding healthcare changes to healthcare delivery and payment within the primary care practice environment, states a new survey from the Commonwealth Fund and The Kaiser Family Foundation. Although healthcare providers’ viewpoints about health information technology’s impact upon quality care are “generally positive,” they are split on the increasing utilization of accountable care organizations (ACOs), says the study. Physicians confirm negativity regarding the overall operation and execution of Medicare and Medicaid payments.

This online/mail survey of over 1,600 primary care physicians and 525 midlevel clinicians – such as nurse practitioners and physician assistants – was conducted within an approximate three-month period earlier this year. According to the survey, healthcare providers’ involvement with innovative care models and healthcare changes are “varied.”

A little more than half of primary care physicians state they are receiving financial incentives based on the quality or efficiency of care. One in three physicians is paid exclusively on a fee-for-service basis, says the Commonwealth Fund. Additionally, there is a lower level of ACO participation confirmed for nurse practitioners and physician assistants in comparison with physicians. Many nurse practitioners and physician assistants are reportedly “unsure” whether or not their practice is involved in ACO initiatives, says the Commonwealth Fund.

Physicians practicing within an ACO-based environment confirm a variety of viewpoints. “Providers were more negative about the use of quality metrics to assess their performance, even those providers who receive incentive payments based on quality,” states the Commonwealth Fund. “Nearly half of physicians and about a quarter of nurse practitioners and physician assistants said recent trends in health care are causing them to consider early retirement. However, a large majority of providers report satisfaction with their medical practice overall, consistent with historical data over the past two decades,” the organization adds.

Summary of survey highlights

According to the Commonwealth Fund, “Current efforts to change primary care payment — that is, using new models that replace fee-for-service payment with other approaches — have been accelerated by provisions in the [Affordable Care Act] ACA.” Here are highlights from the survey:

• Sixty-four percent (two-thirds) of surveyed physicians report they are paid by capitation, salary, or a combination of both.
• Almost 90 percent of nurse practitioners and physician assistants claim receiving payment via mechanisms that are not exclusively fee-for-service.
• Over one-third of physicians are still paid exclusively via fee-for-service.
• Over half of physicians and over one-third of nurse practitioners state they receive incentives or payments according to standards of care quality, patient experience, or care efficiency.
• One-third of nurse practitioners and physician assistants are “unsure” about whether or not they receive such incentives. A “substantial” amount of healthcare providers – 28 percent of physicians and over half of nurse practitioners and physician assistants – confirm they are unsure.
• Twenty-nine percent of primary care physicians state they participate in an ACO arrangement via Medicare or with a private insurer. Thirty-four percent of those primary care physicians who accept Medicare confirm they additionally participate.
• Thirty percent of physicians confirm receiving incentives or payments for qualifying as a patient-centered medical home PCMH or via ACA’s Advanced Primary Care Practice (APCP) medical home demonstration.
• 1 in 6 providers report their practice was recently acquired or consolidated by a group practice, hospital, etc.
• Only 16 percent of physicians accepting Medicaid rated ease of reimbursement highly.

Despite the plethora of the aforementioned findings, the survey confirms that physician satisfaction levels remain level and have done so throughout the past two decades. “As primary care transformation efforts mature and spread, it will remain important to judge their effects on patients in terms of access, quality, and costs of care. However, it is also important to assess their effect on primary care clinicians,” confirms the Commonwealth Fund. “Of concern, nearly half of primary care physicians say that recent trends in health care are causing them to consider retiring earlier than planned. Market trends in health care have been affecting physicians’ satisfaction for more than 20 years. It will be important to monitor providers’ satisfaction with delivery reform efforts.”