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Using administrative data to identify naturally occurring networks of physicians.

ABSTRACT: Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries.To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs.Using nationally representative claims data from the Medicare program for CY 2006 on 51 hospital referral regions (HRRs), we used a network science-based community-detection algorithm to identify groups of physicians likely to have preestablished relationships. After assigning patients to networks based upon visits with a primary care physician, we examined the proportion of care delivered within communities and compared our results with potential ACOs organized around single hospitals.We studied 4,586,044 Medicare beneficiaries from 51 HRRs who were seen by 68,288 active physicians practicing in those HRRs. The median community-based network ACO had 150 physicians with 5928 ties, whereas the median hospital-based network ACO had 96 physicians with 3276 ties. Among patients assigned to networks via their primary care physicians, seventy-seven percent of physician visits occurred with physicians in the community-based networks as compared with 56% with physicians in the hospital-based networks; however, just 8% of specialist visits were to specialists within the hospital-based networks as compared with 60% of specialist visits within the community-based networks. Some markets seemed better suited to developing ACOs based on network communities than others.We present a novel approach to identifying groups of physicians that might readily function as ACOs. Organic networks identified and defined in this natural and systematic manner already have physicians who exhibit close working relationships, and who, importantly, keep the vast majority of care within the networks.

SUBMITTER: Landon BE

PROVIDER: S-EPMC3723338 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Using administrative data to identify naturally occurring networks of physicians.

Landon Bruce E BE Onnela Jukka-Pekka JP Keating Nancy L NL Barnett Michael L ML Paul Sudeshna S O'Malley Alistair J AJ Keegan Thomas T Christakis Nicholas A NA

Medical care 20130801 8

<h4>Background</h4>Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries.<h4>Objectives</h4>To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs.<h4>Research design, subjects, and measures</h4>Using nationally representative claims data from the Medicare program for CY 2006 on 51 hospital referral regions ( ...[more]

PMID: 23807593

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Project description:ObjectivesMedical Regulatory Authorities (MRAs) provide licences to physicians and monitor those physicians once in practice to support their continued competence. In response to physician shortages, many Canadian MRAs developed alternative licensure routes to allow physicians who do not meet traditional licensure criteria to obtain licences to practice. Many physicians have gained licensure through alternative routes, but the performance of these physicians in practice has not been previously examined. This study compared the performance of traditionally and alternatively licenced physicians in Ontario using quality indicators of primary care. The purpose of this study was to examine the practice performance of alternatively licenced physicians and provide evaluative evidence for alternative licensure policies.DesignA cross-sectional retrospective examination of Ontario health administrative data was conducted using Poisson regression analyses to compare the performance of traditionally and alternatively licenced physicians.SettingPrimary care in Ontario, Canada.ParticipantsAll family physicians who were licenced in Ontario between 2000 and 2012 and who had complete medical billing data in 2014 were included (n=11 419).Outcome measuresPrimary care quality indicators were calculated for chronic disease management, preventive paediatric care, cancer screening and hospital readmission rates using Ontario health administrative data.ResultsAlternatively licenced physicians performed similarly to traditionally licenced physicians in many primary care performance measures. Minimal differences were seen across groups in indicators of diabetic care, congestive heart failure care, asthma care and cancer screening rates. Larger differences were found in preventive care for children less than 2 years of age, particularly for alternatively licenced physicians who entered Ontario from another Canadian province.ConclusionsOur findings demonstrate that alternatively licenced physicians perform similarly to traditionally licenced physicians across many indicators of primary care. Our study also demonstrates the utility of administrative data for examining physician performance and evaluating medical regulatory policies and programmes.

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Using administrative data to identify naturally occurring networks of physicians.

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Using administrative data to identify naturally occurring networks of physicians.

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