Background and Goal: The Transforming Clinical Practice Initiative was a four-year nationwide program aimed at improving outpatient health care quality. The initiative, funded by the Centers for Medicare & Medicaid Services, also prepared practices for payment systems based on care quality rather than service quantity and included a Change Package to guide practice transformations. This research brief examines whether these transformations were associated with reductions in emergency department visits among both primary and specialty care practices.
Study Approach: Researchers analyzed data from 3,773 practices in the Transforming Clinical Practice Initiative, serving 3.8 million Medicare beneficiaries. They used the Practice Assessment Tool, developed as part of the initiative, to measure progress on various care milestones. Emergency department visit rates before and after these transformations between April 2015 and September 2021 were compared, adjusting for various factors, to determine if improved practice scores were linked to reduced emergency department visits.
Main Results: By the second follow-up year, a 40-percentage point improvement in the Practice Assessment Tool score was associated with a 6% reduction in emergency department visits for primary care practices and a 4% reduction for specialty care practices. This translates to 31 fewer emergency department visits per 1,000 beneficiaries per year for primary care and 19 fewer for specialty care. For primary care practices, improvements in five specific areas were linked to a reduction in emergency department visits:Population management, measuring and documenting value and quality improvement strategy, behavioral health integration, coordinated care, and enhanced access. For specialty care practices, improvements in two areas—population management and enhanced access—were linked to a reduction in emergency department visits.
Why It Matters: The study shows that comprehensive practice transformation efforts may significantly reduce costly emergency department visits, supporting the Centers for Medicare & Medicaid Services' goals. A national reduction of 6% in ED visits could save Medicare up to $1.38 billion annually.
Practice Transformation in the Transforming Clinical Practice Initiative and Emergency Department Use
Lori Timmins, PhD, et al
Mathematica, Chicago, Illinois
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