Others do the opposite, using any acute care visit to address additional problems, thereby reducing follow-up visits. Some emphasize “throughput,” scheduling as many patients as possible by focusing on the specific reason for the visit. 1,2 Little is known about PCP responses to increasing patient loads. Primary care physicians (PCPs) are increasingly working in large groups, often feeling pressured to see more patients while dealing with demanding electronic health record (EHR) systems. Cannot be readily identified by specialty, age, or sex it is their behavior that matters.Have sicker panels not accounted for by simple capitation models.Are undercompensated (per clinical work hour) by traditional fee-for-service models.Spend more time messaging and using the electronic health record.See fewer patients per day with longer visits.Lower annual costs, due to less specialty care.Comparable overall patient experience scores, in spite of longer waits.Relative to primary care physicians who typically focus only on the patient’s main problem during an acute care visit, those also addressing chronic issues (the max-packers) achieve: Alternatives to compensation just for face-to-face visits and using more flexible scheduling may be needed to support max-packing. PCPs with less appointment availability and who used a mix of appointment slots were more likely to be max-packers.Ĭonclusions: Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time. Max-packers spent 40 minutes more per clinical day using the EHR. Patients of focused PCPs used 7.3% more specialist services, in terms of costs, than patients of max-packers ($1218 vs $1136 P <.001).
Results: Relative to a focused pattern of care, max-packing was associated with 3.4% lower overall resource use, consistently better scores for the available clinical quality metrics, and comparable patient experience (except for worse wait time ratings). All measures were risk-adjusted to account for patient mix. Outcomes were resource use, clinical quality metrics, patient-reported experience, physician time using the EHR, and physician productivity. The top one-third (max-packers) addressed 25.4% more “other problems” than expected, while focused PCPs (bottom one-third) addressed 20.3% fewer than expected. Methods: PCPs were ranked each year by their number of additional conditions addressed during acute care visits. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. Study Design: Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. ABSTRACTObjectives: To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient’s acute problem, versus the max-packers, who typically address additional conditions also.
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