Taressa K Fraze1, Valerie A Lewis2, Andrew Wood3, Helen Newton4, Carrie H Colla3. 1. Department of Family and Community Medicine, Healthforce Center, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA. Taressa.Fraze@ucsf.edu. 2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 3. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 4. School of Public Health, Yale University, New Haven, CT, USA.
Abstract
BACKGROUND: There are concerns about the capacity of rural primary care due to potential workforce shortages and patients with disproportionately more clinical and socioeconomic risks. Little research examines the configuration and delivery of primary care along the spectrum of rurality. OBJECTIVE: Compare structure, capabilities, and payment reform participation of isolated, small town, micropolitan, and metropolitan physician practices, and the characteristics and utilization of their Medicare beneficiaries. DESIGN: Observational study of practices defined using IQVIA OneKey, 2017 Medicare claims, and, for a subset, the National Survey of Healthcare Organizations and Systems (response rate=47%). PARTICIPANTS: A total of 27,716,967 beneficiaries with qualifying visits who were assigned to practices. MAIN MEASURES: We characterized practices' structure, capabilities, and payment reform participation and measured beneficiary utilization by rurality. KEY RESULTS: Rural practices were smaller, more primary care dominant, and system-owned, and had more beneficiaries per practice. Beneficiaries in rural practices were more likely to be from high-poverty areas and disabled. There were few differences in patterns of outpatient utilization and practices' care delivery capabilities. Isolated and micropolitan practices reported less engagement in quality-focused payment programs than metropolitan practices. Beneficiaries cared for in more rural settings received fewer recommended mammograms and had higher overall and condition-specific readmissions. Fewer beneficiaries with diabetes in rural practices had an eye exam. Most isolated rural beneficiaries traveled to more urban communities for care. CONCLUSIONS: While most isolated Medicare beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care. Rural practices reported similar care capabilities to urban practices, suggesting that despite differences in workforce and demographics, rural patterns of primary care delivery are comparable to urban.
BACKGROUND: There are concerns about the capacity of rural primary care due to potential workforce shortages and patients with disproportionately more clinical and socioeconomic risks. Little research examines the configuration and delivery of primary care along the spectrum of rurality. OBJECTIVE: Compare structure, capabilities, and payment reform participation of isolated, small town, micropolitan, and metropolitan physician practices, and the characteristics and utilization of their Medicare beneficiaries. DESIGN: Observational study of practices defined using IQVIA OneKey, 2017 Medicare claims, and, for a subset, the National Survey of Healthcare Organizations and Systems (response rate=47%). PARTICIPANTS: A total of 27,716,967 beneficiaries with qualifying visits who were assigned to practices. MAIN MEASURES: We characterized practices' structure, capabilities, and payment reform participation and measured beneficiary utilization by rurality. KEY RESULTS: Rural practices were smaller, more primary care dominant, and system-owned, and had more beneficiaries per practice. Beneficiaries in rural practices were more likely to be from high-poverty areas and disabled. There were few differences in patterns of outpatient utilization and practices' care delivery capabilities. Isolated and micropolitan practices reported less engagement in quality-focused payment programs than metropolitan practices. Beneficiaries cared for in more rural settings received fewer recommended mammograms and had higher overall and condition-specific readmissions. Fewer beneficiaries with diabetes in rural practices had an eye exam. Most isolated rural beneficiaries traveled to more urban communities for care. CONCLUSIONS: While most isolated Medicare beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care. Rural practices reported similar care capabilities to urban practices, suggesting that despite differences in workforce and demographics, rural patterns of primary care delivery are comparable to urban.
Authors: Joanna G Katzman; Kevin Galloway; Cynthia Olivas; Kimberly McCoy-Stafford; Daniel Duhigg; George Comerci; Summers Kalishman; Chester C Buckenmaier; Laura McGhee; Kristin Joltes; Andrea Bradford; Brian Shelley; Jessica Hernandez; Sanjeev Arora Journal: Mil Med Date: 2016-03 Impact factor: 1.437
Authors: Kevin A Matthews; Janet B Croft; Yong Liu; Hua Lu; Dafna Kanny; Anne G Wheaton; Timothy J Cunningham; Laura Kettel Khan; Ralph S Caraballo; James B Holt; Paul I Eke; Wayne H Giles Journal: MMWR Surveill Summ Date: 2017-02-03