This issue brief from The Commonwealth Fund and the Kaiser Family Foundation reports the results of a national survey of primary care providers (physicians, nurse practitioners, and physician assistants) about their views on recent trends 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. The survey was conducted online and by mail between January 5 and March 30, 2015 among 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.
About two-thirds of the surveyed primary care physicians (64%) reported they are paid either by capitation (i.e., prepayments for a set of services for a defined number of patients) or salary (i.e., predetermined income for an entire panel of patients) or through a combination of capitation, salary, and fee-for-service. However, about a third of primary care physicians (34%) are still paid exclusively on a fee-for-service basis. Meanwhile, nearly nine of 10 of the surveyed nurse practitioners and physician assistants (87%) reported receiving payment through mechanisms that are not exclusively fee-for-service.
About 30 percent of surveyed physicians reported receiving incentives or payments for qualifying as a patient-centered medical home or advanced primary care demonstration site. Twenty-nine percent of the surveyed primary care physicians said they participate in an accountable care organization (ACO) arrangement with Medicare or private insurers. In comparison, about one-quarter (26%) of the surveyed nurse practitioners and physician assistants said their practices qualified as a patient-centered medical home or an advanced primary care practice, and fewer than two of 10 (18%) nurse practitioners and physician assistants reported currently participating in an ACO. Interestingly, a substantial percentage of the surveyed providers (28% of physicians, and 56% of nurse practitioners and physician assistants) were unsure whether their practices participate in ACO arrangements.
The survey finds that about one of six providers (17% of physicians and 16% of nurse practitioners and physi- cian assistants) reported their practices were acquired by or consolidated with a group practice, hospital, or another type of organization within the past two years. Nearly half (47%) of physicians and about a quarter (27%) of nurse practitioners and physician assistants said that recent trends in health care are causing them to consider retiring earlier than they originally thought they would. However, about one of six in each group said that trends are making them consider delaying their retirement (18% of physicians and 17% of nurse practitioners and physician assistants), while a third (34%) of physicians and more than half (56%) of nurse practitioners and physician assistants said these trends are not having much impact on their retirement plans.