Primary Care Providers' Views of Recent Trends in Health Care Delivery and Payment

Abstract

A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations. Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.

Overview

In recent years, the U.S. primary care delivery system has experienced many changes in the way health care is organized, delivered, and financed. Some of these changes have been strengthened or accelerated by the Affordable Care Act (ACA). For instance, there has been an increased use of health information technology, a move toward team-based care and using nonphysician clinicians, an effort to better coordinate care through medical homes and accountable care organizations, and the introduction of financial incentives and quality metrics to determine how providers are paid.

Using data from the Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers, this brief examines providers’ opinions about the changes in primary care payment and health care delivery. Between January 5 and March 30, 2015, a nationally representative sample of 1,624 primary care physicians and a separate sample of 525 midlevel clinicians (i.e., nurse practitioners and physician assistants) working in primary care practices were surveyed online and by mail.

The survey finds that providers’ experiences with new models of care and changes to the health care system are varied. Slightly more than half of primary care physicians reported receiving financial incentives based on the quality or efficiency of care, although one-third of physicians continue to be paid exclusively on a fee-for-service basis. Three of 10 primary care physicians said their practice is qualified as a patient-centered medical home (PCMH) or advanced primary care practice. A similar share is currently participating in accountable care organizations (ACO). Nurse practitioners and physician assistants reported lower levels of participation in ACOs than did physicians, and many were unsure whether their practice participates in one or not.

Health information technology generally garnered positive opinions. Though seemingly counterintuitive, this finding is consistent with the literature: while providers tend to dislike transitioning from paper-based charts to electronic health record software, they generally accept the promise of HIT as a concept.1 On other trends, primary care providers’ views were divided or skewed negative. Both physicians and midlevel clinicians were more likely to say that increased use of medical homes is having a positive rather than a negative impact on the ability to provide quality care, but large shares said there has been no impact or they are not sure. Among providers working in practices that receive incentives for qualifying as medical homes, views were more positive.

In contrast, physicians’ views tilt negative on the effect ACOs have had on the quality of care, and many are still not sure of their effect. Among physicians working in ACOs, views were divided between positive and negative. Providers were more negative about the use of quality metrics to assess their performance, even those providers who receive incentive payments based on quality. 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.2,3