A recent study (link below) published by the Commonwealth Fund found that smaller primary care practices (small groups were divided into practice sizes of 1-2 physicians and 3-9 physicians) have significantly lower rates of preventable admissions than larger practices (10-19 physicians). This occurred despite the larger practice’s tendency to employ significant greater amounts of continuity of care measures including: the patient-centered medical home, guidelines based reminders, and electronic prescribing. The study’s findings are limited by it being conducted via a survey of 1,045 primary care practices from July 2007 to March 2009, so its data preceded the wide-spread adoption of EHRs, HIEs, ACOs, and Meaningful Use.
Preventable Admission Rate Comparisons by Practice Size Compared to Practices of 10-19 physicians:
- 1-2 Physicians: 33% reduction
- 3-9 Physicians: 27% reduction
In general, consolidation of practices can lead to higher levels and access to specialty care and supports investments in health information technology, adherence to guidelines, and other benefits to patient care. However, larger practices also have greater resources that allow them to invest in business practices. This study suggests that one of primary goals of consolidation, i.e., better coordination of care that facilitates keeping patients from being admitted unnecessary, was not being met between 2007 and 2009. Further study is needed to assess the impact of practice size and adoption of more modern quality of care policies and initiatives, including EHRs, e-Prescribing, ACOs, PCMH, and HIE.
Author: Michael Stearns, MD