title: The relationships of physician practice characteristics to quality of care and costs.
abstract: BACKGROUND
  Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care.
  
  
  METHODS
  Practice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims-computable measures of screening and monitoring, avoidable utilization, risk-adjusted per-beneficiary per-year (PBPY) costs, and the practice's net revenue.
  
  
  RESULTS
  Several characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved screening and monitoring.
  
  
  CONCLUSIONS
  Practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization. However, these relationships are not the only pathways connecting practice characteristics to cost and those additional pathways contain substantial "noise" adding uncertainty to the estimated direct effects. Some of the attributes thought to be important characteristics of accountable care organizations and medical homes appear to be associated with lower quality and no improvement in cost.
authors.affiliation: Medica Research Institute, Minnetonka, MN.
authors.forename: John
authors.initials: J
authors.lastname: Kralewski
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dowd
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
authors.forename: David
authors.initials: D
authors.lastname: Knutson
authors.affiliation: Medica Research Institute, Minnetonka, MN.
authors.forename: Junliang
authors.initials: J
authors.lastname: Tong
authors.affiliation: Medica Research Institute, Minnetonka, MN.
authors.forename: Megan
authors.initials: M
authors.lastname: Savage
mesh_terms: D003365:Costs and Cost Analysis; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006123:Group Practice / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data; D010067:Ownership / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D020379:Risk Adjustment; D014481:United States
keywords: Medical group practice structures; costs; health care organizations; quality of patient care