Characteristics of Office-based Physician Visits, 2015

June 5, 2018

Jill Ashman, Ph.D., Health Statistician

Questions for Jill Ashman, Ph.D., Health Statistician, and Lead Author of “Characteristics of Office-based Physician Visits, 2015

Q: What made you write this report on doctors’ office visits?

JA: Our intent in producing this data brief is to provide the annual summary of National Ambulatory Medical Care Survey (NAMCS) data. Last year we created the format for this NAMCS summary report using 2014 data, and we are currently working on the 2016 summary. These summary reports provide a snapshot of the care provided at office-based physician offices.


Q: Was there a result in your study that surprised you?

JA:  While there is a notable finding in the report, generally the patterns are what we expected to find and are consistent with a similar report looking at office visits in 2014. One notable finding is the relatively low percentage of visits for preventive care among adults 18 years or older (21% for ages 18-64 and 13% for those aged 65 years or older).


Q: What differences or similarities did you see between or among various demographic groups, such as age and sex, in this analysis?

JA:  We noted a number of differences among various groups examined in this report. In terms of visit rates, we found that females visited the doctor’s office at a higher rate than males. We also found that the visit rate for infants and older adults exceeded the rates for those aged 1-64 years.

We also found age variation with primary expected sources of payment, the major reason for a doctor’s office visit, and for the services provided at the physician visit. Medicaid was the primary expected source of payment at a higher percentage of visits by children (38%) than adults, and Medicare was the primary expected source of payment at a higher percentage of visits by adults aged 65 and older (79%) compared with patients under 65 years. Having no insurance at all was at a higher percentage of visits by adults aged 18-64 (9%) than those aged 65 and over (2%). Also, compared with adults, a larger percentage of office visits by children were for either preventive care (33%) or a new problem (41%). Additionally, visits by children (compared with adults) were less likely to include a laboratory test, imaging service, or procedure that was ordered or provided. No variation by age was observed for office visits for an injury or that included an examination or screening service.


Q:  What is new in this report that has not already been published?

JA: This report provides the most recent nationally representative estimates of office-based physician visits in the United States. To our knowledge, age differences in the selected characteristics of patients accessing the doctor’s office in 2015 have not already been published.


Q: What sort of trend data do you have on this topic that will help us see how doctor’s office visits have evolved over time?

JA: With a number of years of data, we can look at trends over time by examining other National Center for Health Statistics reports. We released a similar report last year that looked at age variation in the same selected characteristics of office-based physician visits made in 2014. Comparing the results of both reports shows little change in the patterns of selected characteristics from 2014 to 2015. However, one notable change was an observed increase from 2014 to 2015 in the percentage of health education and counseling services ordered or provided overall and among the three age groups examined.

For older years of data, we provide detailed summary tables on our website going back as far as 2008 that can be used to help see how office-based physician visits have evolved over time. The summary tables can be found here.


Q: What would you say is the take-home message of this report?

JA: The take-home message from this report is that there is a wide variation by age in the characteristics of visits to office-based physicians in the United States in 2015. Larger differences were observed in the services ordered or provided and in the major reason for the office visit between children under 18 years and adults aged 18 or older.

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Characteristics of Office-based Physician Visits, 2014

December 12, 2017

In 2014, most Americans had a usual place to receive health care (86% of adults and 97% of children). A majority of children and adults listed a doctor’s office as the usual place they received care. In 2014, there were an estimated 885 million office-based physician visits in the United States.

A new NCHS report examines office-based physician visit rates by age and sex. It also examines visit characteristics, including insurance status, reason for visit, and services, by age. Estimates use data from the 2014 National Ambulatory Medical Care Survey (NAMCS).

Findings:

  • In 2014, there were an estimated 282 office-based physician visits per 100 persons.
  • The visit rate among females exceeded the rate for males, and the rates for both infants and older adults exceeded the rates for those aged 1–64 years.
  • Compared with other age groups, a higher percentage of visits by adults aged 18–64 indicated no insurance.
  • A larger percentage of visits by children under age 18 years were for either preventive care or a new problem, compared with adults aged 18 and over.
  • Compared with children, a larger percentage of visits by adults included a laboratory test, imaging service, or a procedure being ordered or provided.

Characteristics of Primary Care Physicians in Patient-centered Medical Home Practices: United States, 2013

February 17, 2017

Questions for Esther Hing, Survey Statistician and Lead Author on “Characteristics of Primary Care Physicians in Patient-Centered Medical Home Practices: United States, 2013

Q: Can you define what a patient-centered medical home (PCMH) practice is?

EH: One of several PCMH definitions is that PCMHs provide care that is: comprehensive care provided by a team of providers, patient-centered care, coordinated care, has accessible services, and care focused on quality and safety.


Q: Why did you decide to do a report on PCMH practices?

EH: Although the PCMH has been advocated by the “primary care community” for more than a decade, there are no national estimates that describe characteristics of this model of care delivery. “Primary care community” includes primary care physicians as well as other primary care providers and associated professional societies. The report, based on questions funded by the Assistant Secretary for Planning and Evaluation (ASPE), will inform policy makers of the prevalence of certified PCMH practices in the United States, as well as care attributes of these practices (compared with non-PCMH practices).

Estimates not only serve as benchmark estimates for this model of primary care, but adds to the knowledge base about this type of practice. Payers and the federal government have increasingly funded PCMH demonstrations, and certain payers and states have also increased funding to practitioners in PCMH practices.


Q: Is the first time NCHS has published a report on this topic?

EH: Yes, this is the first year that the PCMH questions have been reported.


Q: What did your report find on primary care physicians in PCMH practices?

EH: The report found that primary care physicians in PCMH practices tended to be in larger practices, and located in urban areas. These findings may be attributed to infrastructure requirements needed for PCMH care delivery. It may also reflect that in 2013, the Centers for Medicare and Medicaid Service (CMS) demonstrations and payment policy supporting chronic care was not yet implemented or was in early stages of development.


Q: Were there any findings that surprised you?

EH: The finding that a substantial percentage of non-PCMH practices have non- physician clinicians and Electronic Health Records suggests that there is untapped potential for a greater number of primary care practices to become PCMHs.

However, the relatively lower participation by solo and small practices as PCMHs suggests the need for assistance or coaching to make this transformation. The ongoing implementation of payment incentives from CMS and elsewhere has encouraged growth of PCMHs. This is a trend that the National Ambulatory Medical Care Survey (NAMCS) can be used to examine for the next few years and beyond.


Physician Office Visits for ADHD in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

January 25, 2017

Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?

MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey.  Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.


Q:  Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?

MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.


Q: Is it true that medication is very often involved in the treatment of ADHD?

MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits.  A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder.  In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.


Q: Was it surprising that 80% of office visits for ADHD involve medication?

MA: It is important to interpret this finding carefully.  Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made.  Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications.  This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not.  Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used.  An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).


Q: Anything else you’d like to address about the report?

MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative.  We chose to investigate several variables to in our analysis that are of interest and provide important information.


State Variation in Preventive Care Visits, by Patient Characteristics, 2012

January 25, 2016

Preventive care visits such as general medical examinations, prenatal visits, and well-baby visits give physicians and other health professionals the opportunity to screen for diseases or conditions, as well as to promote healthy behaviors that may delay or prevent these conditions and reduce subsequent use of emergency or inpatient care.

In an NCHS report, the rate of preventive care visits to office-based physicians is examined by state, patient demographics, and physician specialty. Estimates are based on data from the National Ambulatory Medical Care Survey, a nationally representative survey of visits to office-based physicians.

Findings:

  • In 2012, 61.4 preventive care visits were made to office-based physicians per 100 persons. The female rate (76.6 visits per 100 females) exceeded the male rate (45.4 visits per 100 males) by 69%.
  • Among the 34 most populous states, the rate of preventive care visits exceeded the national rate in 1 state (Connecticut) and was lower than the national rate in 11 states (Arkansas, Indiana, Iowa, Michigan, Missouri, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, and Washington).
  • The rate of preventive care visits to primary care physicians in the 34 most populous states exceeded the national rate in 1 state (Connecticut) and was lower than the national rate in 7 states (Arkansas, Indiana, Iowa, Missouri, North Carolina, Pennsylvania, and Washington).

 


Variation in Physician Office Visit Rates by Patient Characteristics and State, 2012

September 11, 2015

An NCHS report examines the rate of physician office visits by patient age, sex, and state. Visits by adults with private insurance as their expected source of payment were also examined.

Estimates are based on the 2012 National Ambulatory Medical Care Survey, a nationally representative survey of physician office visits. State estimates for the 34 most populous states are available for the first time. State refers to the location of the physician office visit.

Key Findings from the Report:

  • In 2012, there were an estimated 301 physician office visits per 100 persons. The visit rate among females exceeded the rate for males.
  • The rate for adults aged 65 and over was more than twice the rate for adults aged 18–64 and children under age 18 years.
  • Among the 34 most populous states, Missouri had the lowest rate of physician office visits for both adult age groups (18–64 and 65 and over), and Connecticut had the highest rate.
  • The percentage of visits made by adults aged 18–64 with private insurance as the expected source of payment varied across the 34 most populous states, ranging from 53% in New York and Arkansas to 79% in Maryland.

 


Trends in Emergency Department Visits for Ischemic Stroke and Transient Ischemic Attack: United States, 2001–2011

March 31, 2015

Stroke is the fifth leading cause of death in the United States. About 87% of all strokes are ischemic strokes. Transient ischemic attacks (TIAs) cause similar symptoms, but the blockage of blood flow to the brain is temporary. However, about one-third of people who have a TIA will have a stroke within 1 year.

Emergency departments play a critical role in the diagnosis and management of ischemic stroke and TIA. The evaluation of these conditions in the emergency department is similar, so they are combined for this analysis.

A new NCHS report presents recent trends in visits to emergency departments for ischemic stroke or TIA.

Key Findings from the Report:

  • From 2001 through 2011, the rate of emergency department visits for ischemic stroke or transient ischemic attack (TIA) decreased 35% for patients aged 18 and over and 51% for patients aged 55–74.
  • From 2004 through 2011, the percentage of emergency department visits for ischemic stroke or TIA in which the patient arrived by ambulance decreased 41% for patients under 75.
  • The percentage of emergency department visits for ischemic stroke or TIA in which a magnetic resonance imaging (MRI) or computed tomography (CT) test was ordered or provided increased 39% from 2001 through 2011.
  • The percentage of emergency department visits for ischemic stroke or TIA that resulted in admission or transfer to a hospital increased 10% from 2001 through 2011.