The Experts below are selected from a list of 18759 Experts worldwide ranked by ideXlab platform
Laurence C Baker - One of the best experts on this subject based on the ideXlab platform.
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less Physician Practice competition is associated with higher prices paid for common procedures
Health Affairs, 2015Co-Authors: Daniel R Austin, Laurence C BakerAbstract:Concentration among Physician groups has been steadily increasing, which may affect prices for Physician services. We assessed the relationship in 2010 between Physician competition and prices paid by private preferred provider organizations for fifteen common, high-cost procedures to understand whether higher concentration of Physician Practices and accompanying increased market power were associated with higher prices for services. Using county-level measures of the concentration of Physician Practices and county average prices, and statistically controlling for a range of other regional characteristics, we found that Physician Practice concentration and prices were significantly associated for twelve of the fifteen procedures we studied. For these procedures, counties with the highest average Physician concentrations had prices 8–26 percent higher than prices in the lowest counties. We concluded that Physician competition is frequently associated with prices. Policies that would influence Physician pra...
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Physician Practice competition and prices paid by private insurers for office visits
JAMA, 2014Co-Authors: Laurence C Baker, Kate M Bundorf, Anne Beeson Royalty, Zachary LevinAbstract:Importance Physician Practice consolidation could promote higher-quality care but may also create greater economic market power that could lead to higher prices for Physician services. Objective To assess the relationship between Physician competition and prices paid by private preferred provider organizations (PPOs) for 10 types of office visits in 10 prominent specialties. Design and Setting Retrospective study in 1058 US counties in urbanized areas, representing all 50 states, examining the relationship between measured Physician competition and prices paid for office visits in 2010 and the relationship between changes in competition and prices between 2003 and 2010, using regression analysis to control for possible confounding factors. Exposures Variation in the mean Hirschman-Herfindahl Index (HHI) of Physician Practices within a county by specialty (HHIs range from 0, representing maximally competitive markets, to 10 000 in markets served by a single [monopoly] Practice). Main Outcomes and Measures Mean price paid by county to Physicians in each specialty by private PPOs for intermediate office visits with established patients ( Current Procedural Terminology [ CPT ] code 99213) and a price index measuring the county-weighted mean price for 10 types of office visits with new and established patients ( CPT codes 99201-99205, 99211-99215) relative to national mean prices. Results In 2010, across all specialties studied, HHIs were 3 to 4 times higher in the 90th-percentile county than the 10th-percentile county (eg, for family Practice: 10th percentile HHI = 1023 and 90th percentile HHI = 3629). Depending on specialty, mean price for a CPT code 99213 visit was between $70 and $75. After adjustment for potential confounders, depending on specialty, prices at the 90th-percentile HHI were between $5.85 (orthopedics; 95% CI, $3.46-$8.24) and $11.67 (internal medicine; 95% CI, $9.13-$14.21) higher than at the 10th percentile. Including all types of office visits, price indexes at the 90th-percentile HHI were 8.3% (orthopedics; 95% CI, 5.0%-11.6%) to 16.1% (internal medicine; 95% CI, 12.8%-19.5%) higher. Between 2003 and 2010, there were larger price increases in areas that were less competitive in 2002 than in initially more competitive areas. Conclusions and Relevance More competition among Physicians is related to lower prices paid by private PPOs for office visits. These results may inform work on policies that influence Practice competition.
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Physician Practice size and variations in treatments and outcomes evidence from medicare patients with ami
Health Affairs, 2007Co-Authors: Jonathan D Ketcham, Laurence C Baker, Donna MacisaacAbstract:Little is known about the relationships between Physician Practice size and patient treatments or outcomes. We examined whether the Practice size of attending Physicians was related to within-hospital differences in care for Medicare patients with acute myocardial infarction (AMI). We found that patients treated by solo Physicians were less likely to receive cardiac catheterization and angioplasty within a day of admission and more likely to die than other patients in the same hospital, even after a number of patient and Physician characteristics were taken into account. These differences suggest that solo practitioners are less likely to follow guidelines calling for quick use of angioplasty.
Robert G Brooks - One of the best experts on this subject based on the ideXlab platform.
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The role of information technology usage in Physician Practice satisfaction
Health Care Management Review, 2009Co-Authors: Nir Menachemi, Thomas L. Powers, Robert G BrooksAbstract:Background: Despite the growing use of information technology (IT) in medical Practices, little is known about the relationship between IT and Physician satisfaction. Purpose: The objective of this study was to examine the relationship between Physician IT adoption (of various applications) and overall Practice satisfaction, as well as satisfaction with the level of computerization at the Practice. Methods: Data from a Florida survey examining Physicians' use of IT and satisfaction were analyzed. Odds ratios (ORs), adjusted for Physician demographics and Practice characteristics, were computed utilizing logistic regressions to study the independent relationship of electronic health record (EHR) usage, PDA usage, use of e-mail with patients, and the use of disease management software with satisfaction. In addition, we examined the relationship between satisfaction with IT and overall satisfaction with the current medical Practice. Results: In multivariate analysis, EHR users were 5 times more likely to be satisfied with the level of computerization in their Practice (OR = 4.93, 95% CI = 3.68-6.61) and 1.8 times more likely to be satisfied with their overall medical Practice (OR = 1.77, 95% CI = 1.35-2.32). PDA use was also associated with an increase in satisfaction with the level of computerization (OR = 1.23, 95% CI = 1.02-1.47) and with the overall medical Practice (OR = 1.30, 95% CI = 1.07-1.57). E-mail use with patients was negatively related to satisfaction with the level of computerization in the Practice (OR = 0.69, 95% CI = 0.54-0.90). Last, Physicians who were satisfied with IT were 4 times more likely to be satisfied with the current state of their medical Practice (OR = 3.97, 95% CI = 3.29-4.81). Implications: Physician users of IT applications, especially EHRs, are generally satisfied with these technologies. Potential adopters and/or policy makers interested in influencing IT adoption should consider the positive impact that computer automation can have on medical Practice.
Maureen Spell - One of the best experts on this subject based on the ideXlab platform.
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measuring the quality of Physician Practice by using clinical vignettes a prospective validation study
Annals of Internal Medicine, 2004Co-Authors: John W Peabody, Jeff Luck, Peter A Glassman, Sharad Jain, Joyce Hansen, Maureen SpellAbstract:This study shows that vignettes are a valid tool for measuring the quality of clinical Practice. They are particularly useful for evaluating quality when Practice-based assessment is difficult beca...
Nir Menachemi - One of the best experts on this subject based on the ideXlab platform.
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The role of information technology usage in Physician Practice satisfaction
Health Care Management Review, 2009Co-Authors: Nir Menachemi, Thomas L. Powers, Robert G BrooksAbstract:Background: Despite the growing use of information technology (IT) in medical Practices, little is known about the relationship between IT and Physician satisfaction. Purpose: The objective of this study was to examine the relationship between Physician IT adoption (of various applications) and overall Practice satisfaction, as well as satisfaction with the level of computerization at the Practice. Methods: Data from a Florida survey examining Physicians' use of IT and satisfaction were analyzed. Odds ratios (ORs), adjusted for Physician demographics and Practice characteristics, were computed utilizing logistic regressions to study the independent relationship of electronic health record (EHR) usage, PDA usage, use of e-mail with patients, and the use of disease management software with satisfaction. In addition, we examined the relationship between satisfaction with IT and overall satisfaction with the current medical Practice. Results: In multivariate analysis, EHR users were 5 times more likely to be satisfied with the level of computerization in their Practice (OR = 4.93, 95% CI = 3.68-6.61) and 1.8 times more likely to be satisfied with their overall medical Practice (OR = 1.77, 95% CI = 1.35-2.32). PDA use was also associated with an increase in satisfaction with the level of computerization (OR = 1.23, 95% CI = 1.02-1.47) and with the overall medical Practice (OR = 1.30, 95% CI = 1.07-1.57). E-mail use with patients was negatively related to satisfaction with the level of computerization in the Practice (OR = 0.69, 95% CI = 0.54-0.90). Last, Physicians who were satisfied with IT were 4 times more likely to be satisfied with the current state of their medical Practice (OR = 3.97, 95% CI = 3.29-4.81). Implications: Physician users of IT applications, especially EHRs, are generally satisfied with these technologies. Potential adopters and/or policy makers interested in influencing IT adoption should consider the positive impact that computer automation can have on medical Practice.
Milan R Amin - One of the best experts on this subject based on the ideXlab platform.
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hoarseness and laryngopharyngeal reflux a survey of primary care Physician Practice patterns
Archives of Otolaryngology-head & Neck Surgery, 2014Co-Authors: Ryan Ruiz, Seema Jeswani, Kenneth Andrews, Benjamin Rafii, Benjamin C Paul, Ryan C Branski, Milan R AminAbstract:IMPORTANCE: Current approaches to the diagnosis and subsequent management of specific voice disorders vary widely among primary care Physicians (PCPs). In addition, sparse literature describes current primary care Practice patterns concerning empirical treatment for vocal disorders. OBJECTIVE: To examine how PCPs manage patients with dysphonia, especially with regard to laryngopharyngeal reflux. DESIGN, SETTING, AND PARTICIPANTS: Prospective, questionnaire-based study by an academic laryngology Practice among academic PCPs from all major US geographic regions. MAIN OUTCOMES AND MEASURES: A 16-question web-based survey, distributed via e-mail, concerning management and possible empirical treatment options for patients with dysphonia. RESULTS: Of 2441 Physicians who received the e-mail broadcast, 314 (12.9%) completed the survey. Among those who completed the survey, 46.3% were family practitioners, 46.5% were trained in internal medicine, and 7.2% identified as specialists. Among all respondents, 64.0% preferred to treat rather than immediately refer a patient with chronic hoarseness (symptoms persisting for >6 weeks) of unclear origin. Reflux medication (85.8%) and antihistamines (54.2%) were the most commonly selected choices for empirical treatment. Most Physician respondents (79.2%) reported that they would treat chronic hoarseness with reflux medication in a patient without evidence of gastroesophageal reflux disease. CONCLUSIONS AND RELEVANCE: Most PCPs who responded to our survey report empirically treating patients with chronic hoarseness of unknown origin. Many Physician respondents were willing to empirically prescribe reflux medication as primary therapy, even when symptoms of gastroesophageal reflux disease were not present. These data suggest that PCPs strongly consider reflux a common cause of dysphonia and may empirically treat patients having dysphonia with reflux medication before referral.
