National Health Statistics Reports Number 101  February 17, 2017

Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013 by Esther Hing, M.P.H., Ellen Kurtzman, Ph.D., and Denys T. Lau, Ph.D., National Center for Health Statistics; Caroline Taplin, M.S.P.H., Office of the Assistant Secretary for Planning and Evaluation; and Andrew B. Bindman, M.D., University of California, San Francisco

Abstract Introduction Objective—This report describes the characteristics of primary care physicians in The patient-centered medical patient-centered medical home (PCMH) practices and compares these characteristics home (PCMH) is an enhanced model with those of primary care physicians in non-PCMH practices. of primary care service delivery that Methods—The data presented in this report were collected during the induction is comprehensive and coordinated and interview for the 2013 National Ambulatory Medical Care Survey, a national provides team-based care for all patients probability sample survey of nonfederal physicians who see patients in office settings (1–4). According to the Joint Principles in the United States. Analyses exclude anesthesiologists, radiologists, pathologists, and of the Patient-Centered Medical Home, physicians in community health centers. In this report, PCMH status is self-defined as PCMHs are identified by five core having been certified by one of the following organizations: Accreditation Association attributes: comprehensive care through a for Ambulatory Health Care, The Joint Commission, National Committee for Quality team of care providers, patient-centered Assurance, URAC, or other certifying bodies. Estimates exclude physicians missing care, coordinated care, accessible information on PCMH status. Sample data are weighted to produce national estimates services, and care focused on quality and of physicians and characteristics of their practices. safety (4). The goals of PCMHs are to Results—In 2013, 18.0% of office-based primary care physicians worked in improve the patient experience, improve practices certified as PCMHs. A higher percentage of primary care physicians in population health, and reduce the cost of PCMH practices (68.8%) had at least one physician assistant, nurse practitioner, or care (1–5). certified nurse midwife on staff compared with non-PCMH practices (47.7%).A Interest in the PCMH model has higher percentage of primary care physicians in PCMH practices reported electronic increased as payers, including the federal transmission (69.6%) as the primary method for receiving information on patients government, have funded demonstrations hospitalized or seen in emergency departments compared with non-PCMH practices and payment methods that support it (41.5%). The percentage of primary care physicians in practices reporting quality (6–11). The Innovation Center at the measures or quality indicators to payers or organizations monitoring health care Centers for Medicare & Medicaid quality was higher in PCMH practices (86.8%) compared with non-PCMH practices Services (CMS) has sponsored several (70.2%). demonstrations supporting practices in their efforts to become PCMH certified Keywords: office-based physicians primary care • National Ambulatory Medical Care (6,7). In addition, payers, including CMS, Survey are moving toward higher payment for those who are either PCMH certified or who demonstrate the provision of functions associated with a PCMH (8,9). Some states have implemented statewide

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Page 2 National Health Statistics Reports  Number 101  February 17, 2017 programs that pay more toward primary The 2013 NAMCS sample included copy of the 2013 survey is available at: care for those in PCMHs (10). Medicare 11,212 physicians (10,595 medical https://www.cdc.gov/nchs/ahcd/ahcd_ currently pays practitioners for doctors and 617 doctors of osteopathy). survey_instruments.htm (17). non-face-to-face care coordination Sample physicians were screened at the This study is subject to several services for beneficiaries with multiple time of survey to ensure that they met the limitations. First, the study’s analysis chronic conditions (11). listed criteria. A total of 4,213 physicians excludes primary care physicians Previous studies on PCMH did not meet all of the criteria and were in CHCs due to different sampling practices have been limited to physician therefore ineligible for the study. The strategies. Second, this report excludes organizations, family medicine practices, most frequent reasons for being out of specialty physicians in PCMHs. Finally, Veterans Administration clinics, and scope were that the physician did not the definition of practice size used in federally qualified health centers (12–15). see ambulatory patients, was retired, this report (size at the location where Little is known about the prevalence or was not office-based. Of the 6,999 the sampled physician had the most of these practices nationwide. In 2013, eligible physicians, 4,096 responded to visits) may not accurately reflect the questions were added to the induction the physician induction interview for an total practice size. Practice size in this interview for the National Ambulatory unweighted response rate of 59% (59% report refers only to one location. If the Medical Care Survey (NAMCS) to weighted). Among these respondents, practice had additional physicians at determine PCMH status and describe 1,345 were primary care physicians. other locations, the practice size may be PCMH-related characteristics. This Among the primary care physicians, larger than what is reported here. This is report presents national estimates of 1,192 provided information on PCMH a possibility for 11.7% of the physicians PCMH characteristics among primary certification. described in this study who work at a care physicians in 2013. It also compares practice with two or more locations. characteristics of primary care physicians NAMCS estimates of physicians in by whether they work in a PCMH. Analysis practices with one or more NPCs on staff have been previously published (18). For This report analyzes characteristics comparability with previous estimates, of primary care physicians, defined the estimates presented in this report of Methods as those in family or general practice, physicians in practices with NPCs on internal medicine, or pediatrics. staff exclude responses with missing Data source Moreover, this report analyzes only information on NPCs (4.3%). primary care physicians, because the Data are from NAMCS, an annual, Missing data for other PCMH percentage of specialty physicians in nationally representative survey of characteristics were included in the PCMH-certified practices was too small office-based physicians, conducted by denominator, because missing data were to provide reliable estimates (2.5%). the National Center for Health Statistics. infrequent except for the item on whether This report presents selected NAMCS’ target universe is physicians the practice had someone assisting characteristics of PCMHs, including who provide direct patient care in institutionalized patients with transitions practice size (i.e., the number of office-based practices. Radiologists, back to their communities (9.4%). physicians at the office location where anesthesiologists, and pathologists However, when estimates that excluded the sampled physician had the most were excluded (16). Physicians in the missing data from the denominator visits); whether the office is located community health centers (CHCs) were were recalculated, the findings remained inside or outside a metropolitan statistical excluded from this analysis due to the consistent. area (MSA); the presence of any non- use of different sampling strategies and Differences by selected physician physician clinician (NPC) in the practice, a different sample frame. In addition, the characteristics were examined using such as a physician assistant, nurse data are still in process. t tests for differences in percentages at the practitioner, or certified nurse midwife; The sampling frame for the 2013 p = 0.05 level. A weighted least-squares the use of electronic health record (EHR) NAMCS (not including CHC providers) regression analysis was used to determine or electronic medical record (EMR) comprises all of the physicians listed the significance of trends by practice systems in the practice; the availability in the master files maintained by size. For the weighted least-squares test, and access to patient medical records the American Medical Association the null hypothesis is that the slope, β, of 24 hours a day; the electronic receipt (AMA) and the American Osteopathic the regression line does not significantly of patient information when a patient Association (AOA) approximately differ from zero (i.e.,H : β = 0 and H : is hospitalized or uses an emergency 0 A β ≠ 0). In this modified least-squares 6 months prior to the start of the survey department; whether the practice reports regression, each estimate is weighted by year and who met the following criteria: quality measures or quality indicators the inverse of the standard error (19). ● Office based, as defined by AMA and to either payers or organizations that AOA monitor health care quality; and whether ● Principally engaged in patient care the practice has a person responsible for activities assisting patients with transitions back ● Nonfederally employed to their communities within 72 hours of ● Under age 85 at the time of survey hospital or nursing home discharge. A National Health Statistics Reports  Number 101  February 17, 2017 Page 3

Results ● The percentage of primary care Availability of NPCs in PCMH physicians in PCMH practices was and non-PCMH practices Organization certifying higher in offices located in urban ● NPCs include physician assistants, practice as PCMH MSAs (18.7%) compared with offices located outside of MSAs nurse practitioners, and certified ● In 2013, 18.0% of primary care (11.9%) (Figure 2). nurse midwives. In 2013, the physicians were in PCMH-certified practices (Figure 1). ● Among primary care physicians in PCMH-certified practices, the Certifying organization National Committee for Quality Assurance (NCQA) was the predominant certifying body (41.7% NCQA 7.5% of those certified or 7.5% of all primary care physicians). ● The percentage of physicians in Not certifed as Certifed as Other PCMH PCMH PCMH practices certified by any of 5.6% the remaining organizations (i.e., 82.0% 18.0% the Accreditation Association for Ambulatory Health Care, The Joint Unknown 4.9% Commission, URAC, or others) was 31.1% of those certified or 5.6% of all primary care physicians. ● Estimates of the percentage of physicians in practices certified as PCMH by organizations other than NOTES: PCMH is a patient-centered medical home and NCQA is the National Committee for Quality Assurance. Other NCQA are unstable due to small includes the Accreditation Association for Ambulatory Health Care, The Joint Commission, URAC, and others. Primary care sample sizes. includes family or general practitioners, internists, and pediatricians. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians missing information on PCMH ● For 27.2% of physicians in PCMH status. See Methods for more information. Access Table I–1 at: https://www.cdc.gov/nchs/data/nhsr/nhsr101_table.pdf#1. practices (or 4.9% of all primary SOURCE: NCHS, National Ambulatory Medical Care Survey, 2013. care physicians), the organization Figure 1. Percentage of primary care physicians, by patient-centered medical home status granting PCMH certification was and certifying organization: United States, 2013 unknown.

Practice size and urban 45 45 location of physicians in 41.6 PCMH practices 40 40 ● In 2013, the percentage of primary 35 35 care physicians in PCMH practices 30 30 increased as practice size increased, 25 25 from 6.2% in solo practices to 21.3% 21.3 20 20 18.7 in practices with 2–10 physicians Percent Percent 15 and to 41.6% in practices with 15 11.9 11 or more physicians (Figure 2). 10 10 6.2 On average, physicians in PCMH 5 5 practices worked in larger practices 0 0 (8.1 physicians per practice) Solo 2–10 11 or more MSA2 Non-MSA compared with physicians in physicians physicians1 non-PCMH practices (4.3 1Trend by practice size is statistically significant. physicians). In this report, practice 2Difference by metropolitan statistical area status is statistically significant. NOTES: MSA is metropolitan statistical area. Primary care includes family or general practitioners, internists, and size is the number of physicians at pediatricians. Practice size is the number of physicians at the location where most visits occur. The average number of the office location where the sampled physicians in patient-centered medical home (PCMH) practices is 8.1, while the average number of physicians in non-PCMH practices is 4.3. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, physician had the most visits. If the and pathologists. Estimates exclude physicians missing information on PCMH status. See Methods for more information. Access Table I–2 at: https://www.cdc.gov/nchs/data/nhsr/nhsr101_table.pdf#2. practice had additional physicians at SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. other locations, the practice size may be larger than what is reported here. Figure 2. Percentage of primary care physicians in patient-centered medical home practices, by practice size and metropolitan statistical area status: United States, 2013 Page 4 National Health Statistics Reports  Number 101  February 17, 2017

percentage of primary care ● Seven out of 10 primary care compared with 4 out of 10 primary physicians in PCMH practices physicians in PCMH practices care physicians in non-PCMH (68.8%) with one or more NPCs on (69.6%) reported receiving practices (41.5%). The percentage of staff was higher compared with the information on patients’ physicians who primarily received percentage in non-PCMH practices hospitalization or emergency information through electronic (47.7%) (Figure 3). department visits electronically transmission on patients hospitalized ● The percentage of primary care (i.e., EHR or EMR systems) or seen in emergency departments physicians in PCMH practices (31.3%) with physician assistants on staff was higher than the percentage PCMH Non-PCMH for primary care physicians in 80 non-PCMH practices (19.9%). 70 68.8 ● The percentage of primary care physicians in PCMH practices 60 (45.8%) with nurse practitioners 50 47.7 on staff was also higher than the 45.8 percentage for physicians in 40

Percent 31.3 non-PCMH practices (27.7%). 30 27.7 19.9 20 Practice capabilities of PCMH and non-PCMH practices 10 ● In 2013, 94.2% of primary care Any non-physician One or more physician One or more nurse physicians in PCMH practices 1 1 clinician in practice assistants in practice practitioners in practice1 reported that an EHR or EMR 1Difference between PCMH and non-PCMH percentages is statistically significant. system was used compared with NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and 74.3% in non-PCMH practices pediatricians. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, and pathologists. Non-physician clinicians include physician assistants, nurse practitioners, and certified nurse midwives. Estimates exclude (Figure 4). Higher percentages of physicians missing information on PCMH status or type of non-physician clinician. See Methods for more information. Access Table I–3 at: https://www.cdc.gov/nchs/data/nhsr/nhsr101_table.pdf#3. physicians in solo PCMH practices SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. and PCMH practices with 2–10 physicians used EHR or EMR Figure 3. Percentage of primary care physicians in practices with non-physician clinicians systems compared with non-PCMH on staff, by patient-centered medical home status: United States, 2013 practices of the same sizes. ● A higher percentage of primary care physicians in PCMH practices PCMH Non-PCMH (91.5%) had 24-hour-per-day access 100 96.6 to their patients’ medical records 94.2 91.8 93.9 86.2 compared with those in non-PCMH 83.0 practices (74.1%). Round-the-clock 80 74.3 access to patients’ medical records was greater in PCMH practices with 59.9 two or more physicians compared 60 with non-PCMH practices of the

same size (Figure 5). Percent 40 ● A higher percentage of primary care physicians in PCMH practices (86.8%) reported quality measures 20 or quality indicators to either payers or organizations that monitor health care quality compared with Total1 olo1 2–10 physicians1 11 or more primary care physicians in non-PCMH physicians practices (70.2%). Higher percentages 1Difference between PCMH and non-PCMH percentages is statistically significant. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and of physicians in solo PCMH pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude practices and in PCMH practices physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians missing information on PCMH status. See Methods for more information. Access Table I–4 at: https://www.cdc.gov/nchs/ with 2–10 physicians reported data/nhsr/nhsr101_table.pdf#4. quality measures compared with SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. non-PCMH practices of the same Figure 4. Percentage of primary care physicians in practices using electronic health record sizes (Figure 6). or electronic medical record systems, by practice size: United States, 2013 National Health Statistics Reports  Number 101  February 17, 2017 Page 5

was higher among those in practices PCMH Non-PCMH with 2–10 physicians (73.8%) 98.9 compared with those in similarly 100 sized non-PCMH practices (47.9%) 91.5 92.4 90.6 (Figure 7). The same pattern was 80 77.7 observed among physicians in solo 74.1 73.2 PCMH practices, but the difference 66.8 was smaller and not statistically 60 significant. ● NPCs were more likely to be on staff

Percent in PCMH practices compared with 40 non-PCMH practices, both overall (68.8% compared with 47.7%) and 20 among practices with one physician on staff (52.0% compared with 29.5%). Greater availability of NPCs in PCMH practices followed the Total1 Solo 2–10 physicians1 11 or more physicians1 same pattern in the larger practice size categories (2–10 and 11 or more 1Difference between PCMH and non-PCMH percentages is statistically significant. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and physicians), although the differences pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians were smaller and not statistically missing information on PCMH status. See Methods for more information. Access Table I–5 at: https://www.cdc.gov/nchs/ data/nhsr/nhsr101_table.pdf#5. significant (Figure 8). SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. ● A higher percentage of primary care physicians in PCMH practices Figure 5. Percentage of primary care physicians in practices with access to patient medical (52.6%) reported that someone in records 24 hours a day, by practice size: United States, 2013 the practice was responsible for assisting patients with transitions back to their communities within PCMH Non-PCMH 72 hours of hospital or nursing home discharge compared with 100 non-PCMH practices (37.5%). A higher 86.8 89.4 88.2 85.8 83.9 percentage of physicians in PCMH 80 practices with 2–10 physicians had a 70.2 72.0 person responsible for transitioning 65.5 patients back to their communities 60 compared with non-PCMH practices of the same size (Figure 9). The

Percent 40 same pattern was observed for solo practices and practices with 11 or more physicians, but the differences 20 were not statistically significant. ● The observed difference was not statistically significant in the receipt of information on patients’ Total1 Solo1 2–10 physicians1 11 or more physicians hospitalizations or emergency department visits by fax between 1Difference between PCMH and non-PCMH percentages is statistically significant. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and primary care physicians in non-PCMH pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude practices compared with those in physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians missing information on PCMH status. See Methods for more information. Access Table I–6 at: https://www.cdc.gov/nchs/ PCMH practices (Figure 10). data/nhsr/nhsr101_table.pdf#6. SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013.

Figure 6. Percentage of primary care physicians in practices reporting quality measures Discussion or quality indicators to either payers or organizations that monitor health care quality, by practice size: United States, 2013 The PCMH model is designed to improve health care in America by transforming how primary care is organized and delivered (3). According to the Joint Principles of the Patient-Centered Medical Home, five Page 6 National Health Statistics Reports  Number 101  February 17, 2017 core attributes of PCMHs include: This report presents national estimates physicians working in PCMH practices comprehensive care through a team of on the characteristics of primary care identified NCQA as the certifying body care providers, patient-centered care, physicians in PCMH-certified practices. (41.7% of those certified or 7.5% of coordinated care, accessible services, and Although multiple organizations all primary care physicians). Although care focused on quality and safety (4). certified practices as PCMHs, most NCQA was the most frequent PCMH- certifying organization, the various PCMH recognition programs vary in PCMH Non-PCMH the amount of required documentation, application costs, and overall efforts. This 80 73.8 report, however, did not address these 69.6 70.7 66.8 issues. This report found that primary 60 care physicians were more likely to be in PCMH practices as practice size 46.5 47.9 41.5 increased. PCMH practices may be larger 40 Percent because PCMH certification requires 29.0 infrastructure investment (including health information technology, such 20 as an EHR system) in order to provide the extra services provided by PCMHs (20). Previous studies have found that physician use of EHR systems increases with practice size (21). In Total1 Solo 2–10 physicians1 11 or more physicians addition, funding of primary care

1Difference between PCMH and non-PCMH percentages is statistically significant. services typically does not cover the NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and extra services provided by PCMHs (20). pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians Most PCMH demonstrations included missing information on PCMH status. See Methods for more information. Access Table I–7 at: https://www.cdc.gov/nchs/ data/nhsr/nhsr101_table.pdf#7. additional payments to PCMHs to SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. compensate for this funding gap (6–10). Finally, the higher presence of primary Figure 7. Percentage of primary care physicians in practices primarily receiving information by electronic transmission on patients hospitalized or seen in emergency departments, by care physicians in PCMH practices practice size: United States, 2013 located in urban areas reflects the high concentration of primary care physicians in urban areas (22). PCMH Non-PCMH This report found that a higher 90 percentage of primary care physicians 82.5 in PCMH practices (68.8%) had NPCs 80 77.1 on staff, such as physician assistants 70 68.8 67.4 and nurse practitioners, compared with 60 58.1 non-PCMH practices (47.7%). NPCs may 52.0 serve as primary care providers and fulfill 50 47.7 other roles on PCMH teams (23–24). 40 Furthermore, this report’s findings Percent 29.5 indicate that primary care physicians in 30 PCMH practices had a greater capacity 20 to provide around-the-clock access to patients’ medical records, perform 10 care coordination, and participate in quality improvements. Compared with Total1 Solo1 2–10 physicians 11 or more primary care physicians in non-PCMH physicians practices, primary care physicians in PCMH practices used EHR or EMR 1Difference between PCMH and non-PCMH percentages is statistically significant. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and systems (94.2%) more frequently, had pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians greater access to patient medical records missing information on PCMH status. See Methods for more information. Access Table I–8 at: https://www.cdc.gov/nchs/ 24 hours per day (91.5%), worked in data/nhsr/nhsr101_table.pdf#8. SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. practices that reported quality measures or quality indicators (86.8%), received Figure 8. Percentage of primary care physicians in practices with one or more information primarily through electronic non-physician clinicians, by practice size: United States, 2013 National Health Statistics Reports  Number 101  February 17, 2017 Page 7 transmission on patients hospitalized transitions back to their communities pattern of higher performance or or seen in an emergency department within 72 hours of hospital or nursing availability of PCMH-related functions (69.6%), and had someone in the practice home discharge (52.6%). Regardless was observed among physicians responsible for assisting patients with of the practice size category, a general in PCMH practices compared with physicians in non-PCMH practices, although some differences were smaller PCMH Non-PCMH and not statistically significant. 60 While this report describes functions 53.4 55.0 available to primary care physicians 52.6 51.6 50 in PCMH practices relative to those 45.9 available to primary care physicians in non-PCMH practices, it does not compare 40 37.5 37.8 35.7 outcomes for patients seen by physicians in PCMH practices with those seen by 30

Percent physicians in non-PCMH practices.

20 References 10 1. The patient centered medical home: History, seven core features, evidence and transformational change. Washington, DC: Total1 Solo 2–10 physicians1 11 or more Robert Graham Center. 2007. Available physicians from: http://www.graham-center.org/ dam/rgc/documents/publications-reports/ 1Difference between PCMH and non-PCMH percentages is statistically significant. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and monographs-books/rgcmo-medical-home. pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude pdf. physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians missing information on PCMH status. See Methods for more information. Access Table I–9 at: https://www.cdc.gov/nchs/ 2. Stange KC, Nutting PA, Miller WL, data/nhsr/nhsr101_table.pdf#9. Jaén CR, Crabtree BF, Flocke SA, Gill SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013. JM. Defining and measuring the patient- Figure 9. Percentage of primary care physicians in practices with person responsible for centered medical home. J Gen Intern transitioning patients back to their communities within 72 hours of being discharged from Med 25(6):601–12. 2010. Available hospital or nursing home, by practice size: United States, 2013 from: http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC2869425/pdf/11606_2010_ Article_1291.pdf. 3. Nielsen M, Buelt L, Patel K, Nichols L. 80 PCMH Non-PCMH The patient-centered medical home’s impact on cost and quality: Annual review of the evidence, 2014–2015. Washington, 64.2 63.6 DC: Patient-Centered Primary Care 59.2 60 58.0 Collaborative. 2016. Available from: 52.4 52.2 http://fmahealth.org/sites/default/ 46.7 files/2015_ANNUAL_EVIDENCE_ 42.4 REPORT.pdf. 40 4. American Academy of Family Physicians, Percent American Academy of Pediatrics, American College of Physicians, 20 American Osteopathic Association. Joint principles of the patient-centered medical home. 2007. Available from: http:// www.aafp.org/dam/AAFP/documents/ practice_management/pcmh/initiatives/ Total Solo 2–10 physicians 11 or more PCMHJoint.pdf. physicians 5. McHugh M, Shi Y, Ramsay P, Harvey JB, Casalino LP, Shortell SM, Alexander JA. NOTES: PCMH is patient-centered medical home. Primary care includes family or general practitioners, internists, and pediatricians. Practice size is the number of physicians at the location where most visits occur. Estimates exclude Patient-centered medical home adoption: physicians in community health centers, anesthesiologists, radiologists, and pathologists. Estimates exclude physicians Results from aligning forces for quality. missing information on PCMH status. See Methods for more information. Access Table I–10 at: https://www.cdc.gov/nchs/ data/nhsr/nhsr101_table.pdf#10. Health Aff (Millwood) 35(1):141–9. 2016. SOURCE: NCHS, National Hospital Ambulatory Medical Care Survey, 2013.

Figure 10. Percentage of primary care physicians in practices primarily receiving information on patients hospitalized or seen in emergency departments by fax, by practice size: United States, 2013 Page 8 National Health Statistics Reports  Number 101  February 17, 2017

6. Centers for Medicare & Medicaid 15. Wiley JA, Rittenhouse DR, Shortell Services. Comprehensive Primary Care SM, Casalino LP, Ramsay PP, Bibi S, et Initiative. Baltimore, MD. Available from: al. Managing chronic illness: Physician https://innovation.cms.gov/initiatives/ practices increased the use of care comprehensive-primary-care-initiative/. management and medical home processes. 7. Silow-Carroll S, Lamphere J. State Health Aff (Millwood) 34(1):78–86. 2015. innovation models: Early experiences 16. National Center for Health Statistics. 2013 and challenges of an initiative to NAMCS micro-data file documentation. advance broad health system reform. 2016. Available from: ftp://ftp.cdc.gov/ Issue Brief (Commonw Fund) 25:1–12. pub/Health_Statistics/NCHS/Dataset_ 2013. Available from: http://www. Documentation/NAMCS/doc2013.pdf. commonwealthfund.org/~/media/Files/ 17. National Center for Health Statistics. Publications/Issue%20Brief/2013/ NAMCS Physician Induction Interview Sep/1706_SilowCarroll_state_innovation_ Form. 2013. Available from: http://www. models_ib1.pdf. cdc.gov/nchs/data/ahcd/2013_NAMCS_ 8. Blue Cross Blue Shield Association. Blue Physician_Induction_Interview_Sample_ Cross and Blue Shield patient-centered Card.pdf. medical home programs are improving the 18. Park M, Cherry D, Decker SL. Nurse practice and delivery of primary care in practitioners, certified nurse midwives, communities nationwide [press release]. and physician assistants in physician 2012. Available from: https://www.pcpcc. offices. NCHS data brief, no 69. org/resource/blue-cross-and-blue-shield- Hyattsville, MD: National Center for patient-centered-medical-home-programs- Health Statistics. 2011. are-improving-practice. 19. Sirken MG, Shimizu I, French DK, 9. Evaluation of the multi-payer advanced Brock DB. Manual on standards and primary care practice (MAPCP) procedures for reviewing statistical demonstration: Third annual report. RTI reports. Hyattsville, MD: National Center International and Urban Institute. 2016. for Health Statistics. 1990. Available from: https://downloads.cms. 20. Landon BE, Gill JM, Antonelli RC, Rich gov/files/cmmi/mapcp-thirdevalrpt.pdf. EC. Prospects for rebuilding primary care 10. Kaye N, Buxbaum J, Takach M. Building using the patient-centered medical home. medical homes: Lessons learned from Health Aff (Millwood) 29(5):827–34. eight states with emerging programs. 2010. National Academy for State Health 21. Hsiao JC, Hing E, Ashman J. Trends in Policy. 2011. Available from: http://nashp. electronic health record system use among org/sites/default/files/building.medical. office-based physicians: United States, homes_.emerging.states.pdf. 2007–2012. National health statistics 11. Centers for Medicare & Medicaid reports; no 75. Hyattsville, MD: National Services. Chronic care management Center for Health Statistics. 2014. services. Baltimore, MD. Available from: 22. Health Resources & Services https://www.cms.gov/Outreach-and- Administration. Shortage designation. Education/Medicare-Learning-Network- Rockville, MD. Available from: https:// MLN/MLNProducts/Downloads/ bhw.hrsa.gov/shortage-designation. ChronicCareManagement.pdf. 23. Ladden MD, Bodenheimer T, Fishman 12. Gao Y, Nocon RS, Gunter KE, Sharma R, NW, Flinter M, Hsu C, Parchman M, Ngo-Metzger Q, Casalino LP, Chin MH. Wagner EH. The emerging primary care Characteristics associated with patient- workforce: Preliminary observations from centered medical home capability in the primary care team: Learning from health centers: A cross-sectional analysis. effective ambulatory practices project. J Gen Intern Med 31(9):1041–51. 2016. Acad Med 88(12):1830–4. 2013. 13. Goldberg DG, Kuzel AJ. Elements of the 24. Park J. Nurse practitioner and physician patient-centered medical home in family assistant staffing in the patient-centered practices in Virginia. Ann Fam Med 7(4):301–8. 2009. medical homes in New York state. Nurs 14. Nelson KM, Helfrich C, Sun H, Outlook 63(5):593–600. 2015. Hebert PL, Liu CF, Dolan E, et al. Implementation of the patient-centered medical home in the Veterans Health Administration: Associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA Intern Med 174(8):1350–8. 2014. U.S. DEPARTMENT OF FIRST CLASS MAIL HEALTH & HUMAN SERVICES POSTAGE & FEES PAID CDC/NCHS Centers for Disease Control and Prevention PERMIT NO. G-284 National Center for Health Statistics 3311 Toledo Road, Room 4551, MS P08 Hyattsville, MD 20782–2064

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National Health Statistics Reports  Number 101  February 17, 2017

Suggested citation Copyright information National Center for Health Statistics Hing E, Kurtzman E, Lau DT, et al. All material appearing in this report is in Charles J. Rothwell, M.S., M.B.A., Director Characteristics of primary care physicians the public domain and may be reproduced Jennifer H. Madans, Ph.D., Associate Director in patient-centered medical home practices: or copied without permission; citation as to for Science United States, 2013. National health statistics source, however, is appreciated. reports; no 101. Hyattsville, MD: National Center Division of Health Care Statistics for Health Statistics. 2017. Denys T. Lau, Ph.D., Acting Director Alexander Strashny, Ph.D., Associate Director for Science

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