--- title: "PCP practice styles and quality, cost, productivity. | Sutter Health" description: "Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time." url: "https://www.sutterhealth.org/research/publications/pcp-practice-styles-and-quality-cost-productivity-1055312774" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. PCP practice styles and quality, cost, productivity. # Primary care physician practice styles and quality, cost, and productivity. Luft HS, Liang SY, Eaton LJ, & Chung S. _Am J Manag Care. 26(4):e127-e134. doi: 10.37765/ajmc.2020.42840._ 2020-04-01 ## Abstract OBJECTIVES: To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient's acute problem, versus the max-packers, who typically address additional conditions also. STUDY DESIGN: Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. METHODS: PCPs were ranked each year by their number of additional conditions addressed during acute care visits. The top one-third (max-packers) addressed 25.4% more "other problems" than expected, while focused PCPs (bottom one-third) addressed 20.3% fewer than expected. Outcomes were resource use, clinical quality metrics, patient-reported experience, physician time using the EHR, and physician productivity. All measures were risk-adjusted to account for patient mix. T tests were used to compare measures. RESULTS: Relative to a focused pattern of care, max-packing was associated with 3.4% lower overall resource use, consistently better scores for the available clinical quality metrics, and comparable patient experience (except for worse wait time ratings). Patients of focused PCPs used 7.3% more specialist services, in terms of costs, than patients of max-packers ($1218 vs $1136; P <.001). Max-packers spent 40 minutes more per clinical day using the EHR. PCPs with less appointment availability and who used a mix of appointment slots were more likely to be max-packers. CONCLUSIONS: Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time. Alternatives to compensation just for face-to-face visits and using more flexible scheduling may be needed to support max-packing. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/32270990) ![Su-Ying Liang, Ph.D.](https://dyn.mktgcdn.com/p/cRIUee_GK3HEL1Wq8svqoUApvABjlwVVA-KUHVGzuNw/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Su-Ying Liang, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Patient-centric scheduling with the implementation of health information technology to improve the patient experience and access to care: retrospective case-control analysis.](https://www.sutterhealth.org/research/publications/pt-centric-scheduling-with-hit-to-improve-pt-experience-1055312790) Chung S, Martinez MC, Frosch DL, Jones VG, Chan AS. J Med Internet Res. 22(6):e16451. doi: 10.2196/16451. 2020 Jun 10 - Publication ### [Implementation of departmental quality strategies is positively associated with clinical practice: results of a multicenter study in 73 hospitals in 7 European countries.](https://www.sutterhealth.org/research/publications/quality-strategies-assoc-clinical-practrace-1055312466) Sunol R, Wagner C, Arah OA, Kristensen S, Pfaff H, Klazinga N, Thompson CA, Wang A, DerSarkissian M, Bartels P, Michel P, Groene O; DUQuE Project Consortium. PLoS One. 10(11):e0141157. doi: 10.1371/journal.pone.0141157. 2015 Nov 20 - Publication ### [Leveraging electronic health records to develop measurements for processes of care.](https://www.sutterhealth.org/research/publications/leverage-ehrs-to-measure-care-processes-1055312664) Tai-Seale M, Wilson CJ, Panattoni L, Kohli N, Stone A, Hung DY, Chung S. Health Serv Res. 49(2):628-44. doi: 10.1111/1475-6773.12126. Epub 2013 Nov 18. 2014 Apr 01 - Publication ### [Features of patient-centered primary care and the use of ambulatory care.](https://www.sutterhealth.org/research/publications/pt-centered-prim-care-and-use-ambul-care-1055312443) Wong P, Panattoni L, Tai-Seale M. Popul Health Manag. doi: 10.1089/pop.2016.0079. \[Epub ahead of print\] Send to 2017 Jan 11 - Publication ### [Pragmatic study of clinician use of a personalized patient decision aid integrated into the electronic health record: an 8-year experience.](https://www.sutterhealth.org/research/publications/clinician-use-of-patient-decision-aid-integrated-into-ehr-1055312641) Coylewright M, Keevil JG, Xu K, Dodge SE, Frosch D, Field ME. Telemed J E Health. doi: 10.1089/tmj.2019.0112. \[Epub ahead of print\] 2019 Aug 05 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/pcp-practice-styles-and-quality-cost-productivity-1055312774#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"PCP practice styles and quality, cost, productivity."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/pcp-practice-styles-and-quality-cost-productivity-1055312774#medicalscholarlyarticle","name":"Primary care physician practice styles and quality, cost, and productivity.","headline":"PCP practice styles and quality, cost, productivity.","abstract":"OBJECTIVES: To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient's acute problem, versus the max-packers, who typically address additional conditions also. STUDY DESIGN: Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. METHODS: PCPs were ranked each year by their number of additional conditions addressed during acute care visits. The top one-third (max-packers) addressed 25.4% more \"other problems\" than expected, while focused PCPs (bottom one-third) addressed 20.3% fewer than expected. Outcomes were resource use, clinical quality metrics, patient-reported experience, physician time using the EHR, and physician productivity. All measures were risk-adjusted to account for patient mix. T tests were used to compare measures. RESULTS: Relative to a focused pattern of care, max-packing was associated with 3.4% lower overall resource use, consistently better scores for the available clinical quality metrics, and comparable patient experience (except for worse wait time ratings). Patients of focused PCPs used 7.3% more specialist services, in terms of costs, than patients of max-packers ($1218 vs $1136; P \u003c.001). Max-packers spent 40 minutes more per clinical day using the EHR. PCPs with less appointment availability and who used a mix of appointment slots were more likely to be max-packers. CONCLUSIONS: Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time. 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