Capitated Payments and the Delivery of Patient Education
Capitated Payments and the Delivery of Patient Education
Introduction: Patient education is a critical component of the patient-centered medical home and is a powerful and effective tool in chronic disease management. However, little is known about the effect of practice payment on rates of patient education during office encounters.
Methods: For this study we took data from the 2009 National Ambulatory Medical Care Survey. This was a cross-sectional analysis of patient visits to primary care providers to determine whether practice payment in the form of capitated payments is associated within patient education being included more frequently during office visits compared with other payment methods.
Results: In a sample size of 9863 visits in which capitation status was available and the provider was the patient's primary care provider, the weighted percentages of visits including patient education were measured as a percentages of education (95% confidence intervals): <25% capitation, 42.7% (38.3–47.3); 26% to 50% capitation, 37.6% (23.5–54.2); 51% to 75% capitation, 38.4% (28.1–49.8); >75% capitation, 74.0% (52.2–88.1). In an adjusted logistic model controlling for new patients (yes/no), number of chronic conditions, number of medications managed, number of previous visits within the year, and age and sex of the patients, the odds of receiving education were reported as odds ratios (95% confidence intervals): <25% capitation, 1.00 (1.00–1.00); 26% to 50% capitation, 0.77 (0.38–1.58); 51% to 75% capitation, 0.81 (0.53–1.25); and >75% capitation, 3.38 (1.23–9.30).
Conclusions: Patients are more likely to receive education if their primary care providers receive primarily capitated payment. This association is generally important for health policymakers constructing payment strategies for patient populations who would most benefit from interventions that incorporate or depend on patient education, such as populations requiring management of chronic diseases.
Patient education is an important tool for physicians in preventing the deterioration of health due to illness and for promoting healthy lifestyle choices. Multiple studies have examined interventions involving patient education, including several emphasizing shared decision making. Benefits of greater patient education include improved use of value-based choices, improved patient-practitioner communication, increased involvement of the patient in decision making, and improved knowledge and realistic perception of outcomes. For example, a nurse-led intervention to educate patients regarding nonpharmacologic strategies to reduce gastroesophageal reflux demonstrated reduced patient symptoms; similarly, a patient education program to promote exercise resulted in greater exercise tolerance and fewer costs for patients with chronic obstructive pulmonary disease.
Numerous payment structures, including traditional fee for service, risk-adjusted pay for performance, capitation, and bundled payments, have been discussed by health services researchers with regard to their impact on the quality of care delivered to patients. Recent calls for increased quality of care and reduced cost of care at a population level have focused on the redesign of primary care. Because of the accelerating interest in payment reform and accountable care organizations, there has been renewed interest in the effect of population-based capitated payment on quality of care.
Previous work has shown that there are differences in quality of primary care when comparing traditional fee-for-service payment arrangements to capitated payment systems. It is understood that capitated payment systems have significant effects on how physicians deliver care and how patients trust their physicians. However, the effect of capitated payment structures on the provision of patient education in particular has not been fully elucidated in the literature.
Therefore, we examined the association between the proportion of revenue received through capitation within a given practice and the proportion of patient visits indicating patient education was provided during the visit. We hypothesized that practices with higher levels of capitated payments would more often include patient education as part of a primary care outpatient visit.
Abstract and Introduction
Abstract
Introduction: Patient education is a critical component of the patient-centered medical home and is a powerful and effective tool in chronic disease management. However, little is known about the effect of practice payment on rates of patient education during office encounters.
Methods: For this study we took data from the 2009 National Ambulatory Medical Care Survey. This was a cross-sectional analysis of patient visits to primary care providers to determine whether practice payment in the form of capitated payments is associated within patient education being included more frequently during office visits compared with other payment methods.
Results: In a sample size of 9863 visits in which capitation status was available and the provider was the patient's primary care provider, the weighted percentages of visits including patient education were measured as a percentages of education (95% confidence intervals): <25% capitation, 42.7% (38.3–47.3); 26% to 50% capitation, 37.6% (23.5–54.2); 51% to 75% capitation, 38.4% (28.1–49.8); >75% capitation, 74.0% (52.2–88.1). In an adjusted logistic model controlling for new patients (yes/no), number of chronic conditions, number of medications managed, number of previous visits within the year, and age and sex of the patients, the odds of receiving education were reported as odds ratios (95% confidence intervals): <25% capitation, 1.00 (1.00–1.00); 26% to 50% capitation, 0.77 (0.38–1.58); 51% to 75% capitation, 0.81 (0.53–1.25); and >75% capitation, 3.38 (1.23–9.30).
Conclusions: Patients are more likely to receive education if their primary care providers receive primarily capitated payment. This association is generally important for health policymakers constructing payment strategies for patient populations who would most benefit from interventions that incorporate or depend on patient education, such as populations requiring management of chronic diseases.
Introduction
Patient education is an important tool for physicians in preventing the deterioration of health due to illness and for promoting healthy lifestyle choices. Multiple studies have examined interventions involving patient education, including several emphasizing shared decision making. Benefits of greater patient education include improved use of value-based choices, improved patient-practitioner communication, increased involvement of the patient in decision making, and improved knowledge and realistic perception of outcomes. For example, a nurse-led intervention to educate patients regarding nonpharmacologic strategies to reduce gastroesophageal reflux demonstrated reduced patient symptoms; similarly, a patient education program to promote exercise resulted in greater exercise tolerance and fewer costs for patients with chronic obstructive pulmonary disease.
Numerous payment structures, including traditional fee for service, risk-adjusted pay for performance, capitation, and bundled payments, have been discussed by health services researchers with regard to their impact on the quality of care delivered to patients. Recent calls for increased quality of care and reduced cost of care at a population level have focused on the redesign of primary care. Because of the accelerating interest in payment reform and accountable care organizations, there has been renewed interest in the effect of population-based capitated payment on quality of care.
Previous work has shown that there are differences in quality of primary care when comparing traditional fee-for-service payment arrangements to capitated payment systems. It is understood that capitated payment systems have significant effects on how physicians deliver care and how patients trust their physicians. However, the effect of capitated payment structures on the provision of patient education in particular has not been fully elucidated in the literature.
Therefore, we examined the association between the proportion of revenue received through capitation within a given practice and the proportion of patient visits indicating patient education was provided during the visit. We hypothesized that practices with higher levels of capitated payments would more often include patient education as part of a primary care outpatient visit.
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