Table 5 Quantile regression estimates of the impact of EHR on patient face time per visit (All covariates)
Variables | At mean visit | 10 minute visit | 15 minute visit | 20 minute Visit | 25 minute Visit | 30 minute visit |
|---|---|---|---|---|---|---|
Key independent variables | ||||||
Basic EHR | 0.062*** (0.007) | 0.053*** (0.012) | 0.054*** (0.009) | 0.104*** (0.012) | 0.112*** (0.011) | 0.117*** (0.011) |
Young physician | -0.009 (0.008) | 0.009 (0.010) | 0.010 (0.009) | -0.006 (0.009) | -0.032*** (0.010) | -0.033*** (0.010) |
Older physician | 0.007 (0.008) | -0.014 (0.012) | -0.001 (0.012) | 0.049*** (0.012) | 0.026** (0.013) | 0.030* (0.018) |
Basic EHR * Young physician | 0.005 (0.016) | 0.016 (0.025) | 0.009 (0.021) | -0.027* (0.015) | -0.030 (0.023) | -0.034 (0.024) |
Basic EHR * Older physician | 0.006 (0.020) | -0.053** (0.021) | -0.073*** (0.026) | 0.006 (0.031) | 0.020 (0.051) | 0.025 (0.048) |
Patients’ characteristics | ||||||
Age group: (Ref <18) | ||||||
18-34 | 0.054*** (0.009) | 0.016 (0.013) | 0.045*** (0.015) | 0.021** (0.008) | 0.075*** (0.017) | 0.070*** (0.015) |
35-49 | 0.069*** (0.009) | 0.038*** (0.012) | 0.069*** (0.014) | 0.023*** (0.006) | 0.088*** (0.013) | 0.079*** (0.014) |
50-64 | 0.082*** (0.009) | 0.050*** (0.012) | 0.085*** (0.015) | 0.044*** (0.009) | 0.097*** (0.011) | 0.091*** (0.011) |
≥ 65 | 0.072*** (0.011) | 0.023* (0.014) | 0.066*** (0.017) | 0.031*** (0.010) | 0.085*** (0.013) | 0.080*** (0.017) |
Female | 0.006 (0.005) | 0.007 (0.006) | 0.006 (0.006) | 0.005 (0.005) | 0.017** (0.007) | 0.016* (0.009) |
Race/ethnicity (Ref: White, non-Hispanic) | ||||||
Black, non-Hispanic | -0.039*** (0.007) | -0.012 (0.011) | -0.018 (0.015) | -0.038*** (0.008) | -0.040** (0.016) | -0.044** (0.018) |
Other race, non-Hispanic | -0.017** (0.008) | 0.006 (0.010) | 0.002 (0.008) | -0.019* (0.011) | -0.008 (0.016) | -0.012 (0.017) |
Hispanic | -0.001 (0.007) | 0.026*** (0.008) | 0.019*** (0.006) | -0.010 (0.009) | -0.012 (0.010) | -0.025** (0.012) |
Patient’s health status | ||||||
Major reason for visit (Ref: New problem) | ||||||
Chronic problem | 0.052*** (0.005) | 0.050*** (0.009) | 0.065*** (0.013) | 0.049*** (0.007) | 0.070*** (0.008) | 0.098*** (0.008) |
Pre-/post-surgery or preventive care | 0.159*** (0.006) | 0.092*** (0.012) | 0.102*** (0.014) | 0.201*** (0.009) | 0.295*** (0.009) | 0.273*** (0.008) |
Related to injury/poisoning/ adverse effect | -0.033*** (0.008) | -0.021** (0.009) | -0.022* (0.012) | -0.030*** (0.006) | -0.040*** (0.015) | -0.043*** (0.015) |
Bad disposition (Refer to ED/admit to hospital) | 0.151*** (0.026) | 0.063 (0.041) | 0.063* (0.036) | 0.218*** (0.047) | 0.287*** (0.033) | 0.262*** (0.028) |
Wound care | 0.139*** (0.015) | 0.058** (0.025) | 0.058** (0.025) | 0.111*** (0.029) | 0.196*** (0.032) | 0.206*** (0.040) |
4+ new medications | 0.062*** (0.014) | 0.062*** (0.012) | 0.052*** (0.013) | 0.067*** (0.018) | 0.081*** (0.023) | 0.064*** (0.023) |
1 chronic conditions | 0.027*** (0.006) | 0.013 (0.009) | 0.022* (0.012) | 0.021*** (0.005) | 0.036*** (0.008) | 0.035*** (0.010) |
2 chronic conditions | 0.050*** (0.007) | 0.059*** (0.013) | 0.057*** (0.012) | 0.050*** (0.014) | 0.049*** (0.012) | 0.061*** (0.014) |
3+ chronic conditions | 0.074*** (0.008) | 0.072*** (0.013) | 0.068*** (0.013) | 0.117*** (0.015) | 0.095*** (0.015) | 0.094*** (0.015) |
Visit’s characteristics | ||||||
Visit to own primary care physician | 0.017** (0.007) | 0.030*** (0.008) | 0.034*** (0.006) | 0.024*** (0.009) | 0.003 (0.014) | -0.020 (0.017) |
Referred visit | 0.087*** (0.016) | -0.005 (0.019) | -0.001 (0.016) | 0.114*** (0.027) | 0.121*** (0.024) | 0.091*** (0.021) |
Primary source of payment (Ref: Private insurance) | ||||||
Medicare | -0.001 (0.008) | 0.023*** (0.008) | 0.022** (0.010) | -0.005 (0.011) | 0.002 (0.014) | 0.006 (0.017) |
Medicaid | -0.005 (0.008) | -0.021* (0.011) | -0.007 (0.014) | 0.000 (0.007) | 0.002 (0.012) | 0.015 (0.013) |
Other | 0.009 (0.007) | 0.015* (0.009) | 0.017** (0.008) | 0.002 (0.006) | 0.017* (0.009) | 0.029** (0.013) |
New patient | 0.113*** (0.011) | 0.043*** (0.015) | 0.067*** (0.014) | 0.160*** (0.023) | 0.165*** (0.019) | 0.155*** (0.020) |
Number of visits in last 12 months (Ref: No visit) | ||||||
1 visit | -0.010 (0.012) | -0.011 (0.015) | -0.006 (0.016) | -0.021 (0.015) | -0.002 (0.015) | -0.003 (0.023) |
2 visits | -0.031*** (0.012) | -0.027** (0.013) | -0.018 (0.013) | -0.027* (0.015) | -0.024 (0.016) | -0.031 (0.022) |
3+ visits | -0.031*** (0.010) | -0.021 (0.014) | -0.014 (0.012) | -0.034** (0.014) | -0.040*** (0.013) | -0.044** (0.019) |
Weekend visit | -0.053*** (0.017) | -0.052** (0.026) | -0.082** (0.035) | -0.019 (0.015) | -0.068*** (0.022) | -0.058 (0.035) |
Seen also by non-MD clinician | -0.003 (0.005) | -0.006 (0.005) | -0.003 (0.006) | -0.011 (0.007) | -0.006 (0.008) | 0.003 (0.010) |
Physician characteristics | ||||||
Ownership (Ref: physician or physician group) | ||||||
HMO | 0.070*** (0.020) | 0.094*** (0.032) | 0.057*** (0.018) | 0.102*** (0.021) | 0.024 (0.022) | 0.036 (0.037) |
Community health center | -0.075*** (0.021) | -0.040*** (0.012) | -0.057*** (0.016) | -0.039** (0.019) | -0.060** (0.024) | -0.086*** (0.032) |
Other type of ownership | -0.033*** (0.007) | -0.043*** (0.012) | -0.049*** (0.016) | -0.016* (0.009) | -0.034*** (0.009) | -0.042*** (0.011) |
Solo practice | 0.058*** (0.006) | 0.022*** (0.006) | 0.031*** (0.006) | 0.065*** (0.007) | 0.077*** (0.008) | 0.074*** (0.010) |
Type of office setting (Ref: Private practice) | ||||||
Free standing | 0.001 (0.012) | 0.045** (0.019) | 0.059*** (0.010) | -0.009 (0.015) | -0.051*** (0.013) | -0.092*** (0.018) |
Community health center | 0.090*** (0.020) | 0.080*** (0.016) | 0.094*** (0.017) | 0.077*** (0.023) | 0.067*** (0.024) | 0.082** (0.032) |
HMO | -0.087*** (0.022) | -0.170*** (0.052) | -0.098*** (0.034) | -0.049** (0.020) | -0.084*** (0.020) | -0.103*** (0.029) |
Other type of office setting | 0.133*** (0.026) | 0.160*** (0.031) | 0.140*** (0.021) | 0.132*** (0.045) | 0.159*** (0.059) | 0.134*** (0.034) |
Physician’s incentive to change patient face time | ||||||
Over 50 % of revenue from capitation | -0.057*** (0.012) | -0.041*** (0.014) | -0.038** (0.018) | -0.047*** (0.009) | -0.099*** (0.015) | -0.101*** (0.022) |
Over 50 % of revenue from managed care contract | 0.009 (0.005) | 0.028*** (0.010) | 0.048*** (0.008) | -0.002 (0.006) | -0.008 (0.007) | -0.016** (0.008) |
Over 50 % of revenue from case rate | 0.040** (0.017) | 0.005 (0.024) | -0.019 (0.026) | 0.078*** (0.029) | 0.081** (0.041) | 0.105*** (0.022) |
Other covariates | ||||||
Metropolitan Statistical Area (MSA) | 0.018*** (0.007) | 0.034*** (0.009) | 0.022* (0.013) | 0.007 (0.007) | -0.012 (0.011) | -0.022** (0.011) |
Geographic Region (Ref: Northeast) | ||||||
Midwest | 0.001 (0.007) | -0.056*** (0.018) | -0.092*** (0.021) | 0.002 (0.010) | 0.019* (0.010) | 0.020* (0.011) |
South | 0.005 (0.007) | -0.042** (0.019) | -0.024 (0.016) | 0.009 (0.011) | 0.036*** (0.011) | 0.040*** (0.011) |
West | 0.064*** (0.007) | 0.165*** (0.022) | 0.069*** (0.011) | 0.014 (0.010) | 0.064*** (0.012) | 0.080*** (0.013) |
N = 37,962 |