Regularly seeing a PCP leads to greater savings for Medicare patients
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Key takeaways:
- Regular and more frequent visits to the same clinician were associated with greater Medicare savings.
- The findings take on added importance as practices shift to value-based care.
Patients who had regular primary care visits with the same physician had greater savings in Medicare expenditures and a reduced risk for ED visits and hospitalizations — especially as their care became more complex — a recent study found.
The study adds to previous research, which has shown that continuity of primary care can lower health costs.
According to Dilara Sonmez, MS, BS, a PhD student at the University of Chicago Booth School of Business, and colleagues, patients with irregular care are more likely to receive reactive care opposed to those receiving regular care.
“We hypothesized that the former type of care will be associated with greater costs and acute care utilization than the latter,” they wrote in JAMA Network Open.
The researchers evaluated a cohort of 504,471 Medicare beneficiaries who had at least three primary care visits from 2016 to 2018.
According to the researchers, patients’ visit patterns were measured using the following metrics:
- frequency, defined as “the mean annual number of primary care visits”;
- regularity, or the “variability in the number of days between visits”; and
- continuity of care, which was based on “the extent to which patients obtained their care from their most responsible primary care clinician or organization instead of visiting other primary care clinicians or organizations.”
Patients were also divided into a regular or irregular subgroup, which were then each divided into three subgroups based on high, moderate or no continuity.
Sonmez and colleagues found that savings increased with increased frequency. As regularity and continuity decreased, associations between frequency and savings became inverted, they said.
Compared with patients in the noncontinuous irregular group, patients in the highly continuous regular group saw:
- greater savings (175.87%; 95% CI, 167.4%-184.33%);
- lower risk-adjusted expenditures (–16.61%; 95% CI, –16.73% to –16.48%);
- fewer risk-adjusted ED visits (–40.49%; 95% CI, –40.55% to –40.43%); and
- fewer risk-adjusted hospitalizations (–53.32%; 95% CI, –53.49% to –53.14%).
“The association of proactive care patterns with the highest savings is more remarkable given those patients had lower [risk adjustment factor] scores than other subgroups,” the researchers wrote.
They noted that cost savings were seen only for those in highly continuous care groups regardless of frequency or regularity, and higher frequency of care was associated with cost savings only in the high-continuity group, “which suggests that continuity may be relatively more important than the other two factors.”
Sonmez and colleagues explained that primary care systems under value-based care should be designed to optimize regularity, frequency and continuity of care in combination.
“Proactive approaches to primary care, defined by temporally regular visits with a continuity-of-care clinician at a frequency optimized for clinical complexity, may offer benefits to payers, clinicians, and patients by decreasing expenditures, reducing ED visits, and reducing hospitalizations,” they wrote.
Perspective
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This article builds on the work of previous authors who have established the value of primary health care. Starfield, Franks, Fiscella and others have demonstrated that the use of a primary health care provider to direct patient care reduces both cost and mortality. This study demonstrates that the frequency and timing of primary care visits also plays a role in the total cost of care. The authors found that patients with a greater disease burden had the greatest reduction in cost. Despite the multiple studies demonstrating the value of primary care, the United States is significantly behind other industrialized nations in the percentage of health care provided by primary care. Policymakers and others should take note of these findings and design reimbursement systems that recognize the value provided by PCPs and incentivize more clinicians to choose primary care as their specialty.
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