Is Physician Practice Size Linked to the Quality and Cost of Care?


Large physician practices spend more per person and their patients are readmitted to the hospital at a higher rate than the smallest practices, according to a new Commonwealth Fund–supported study in Health Services Research that focused on Medicare patients with high health care needs.

The research team, led by Lawrence P. Casalino, M.D., of Weill Cornell Medical College, measured quality of care using two key indicators: hospital readmissions within 30 days of discharge and admissions for “ambulatory care–sensitive” conditions, which usually don’t require hospitalization when appropriate outpatient care is provided.

Large practices are often thought to provide better care than small ones, but the study’s results don’t support that assumption. It’s possible, the authors say, that large practices attract patients who are more difficult to treat, and that currently available measures are unable to account for the difference in illness severity. It may also be the case that large practices provide care that costs more than, but is not superior to, care provided by small practices.

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