Ateev Mehrotra

..The association between the organizational structure of physician groups and health care quality has never been evaluated empirically...

..Physician organizations have questioned whether the rules used to attribute costs to a physician affect the cost category to which that physician is assigned...

..Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care...

..To describe improvements in the design of pay-for-performance (P4P) programs that reflect the psychology of how people respond to incentives...

..There is a need for more systematic evaluation of hospital P4P to understand its effect and whether the benefits of investing in P4P outweigh the associated costs...

..These same ten clinical problems make up 13 percent of adult PCP visits, 30 percent of pediatric PCP visits, and 12 percent of ED visits. Whether there will be a future shift of care from EDs or PCPs to retail clinics is unknown...

..Open-access scheduling (also known as advanced access or same-day access) is a popular tool for improving patient access to primary care appointments...

..Better methods for creating provider cost profiles are needed...

..Preventive health examinations (PHEs) are controversial, and limited data are available on their use and content...

..These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines...

..To describe trends in retail clinic use among commercially insured patients and to identify which patient characteristics predict retail clinic use...

..However, no rigorous evaluation has been undertaken to determine whether these tools can accurately distinguish higher-cost physicians from lower-cost physicians...

..Retail clinics are clinics within a retail store that provide simple acute and preventive care services for a fixed price without an appointment...

..In this paper we compare the percentile cut-off method to another method, using statistical testing, for identifying high-cost or low-cost physicians...

..To better understand the potential for retail clinics to achieve this goal, we describe the sociodemographic characteristics of the communities in which they operate...

..If retail clinics had not been available, a quarter of patients report they would have gone to the emergency department. Retail clinics appear to be responding to the need for convenient, affordable, and consumer-centered care...

..However, tiered products may limit access to care because patients may have to travel unreasonable distances to visit the nearest high-value physician...

..To assess the scope and magnitude of pay-for-performance (P4P) incentives among physician groups and to examine whether such incentives are associated with quality improvement initiatives...

..We describe three types of relationships between retail clinics and primary care providers. We argue that for some relationships there is no conflict, and we describe areas of potential concern for others...

..However, more research is needed to ensure that care of equivalent quality is provided at urgent care centers and retail clinics compared to emergency departments...

..We suggest a number of applied studies and demonstrations that would facilitate more rapid movement of episode-based approaches from concept to implementation...

..In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures...

..Our study was designed to describe the use, structure, and content of these programs...

..In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer...

..While use is increasing on average, it is particularly increasing among young, healthy, and higher income patients living close to retail clinics...