Comprehensive Primary Care Impacts Spending

A belief in implementing more effective methods of delivering primary care services is the cornerstone to many initiatives to reducing growth in health spending.  A study published in the Annals of Family Medicine evaluates the link, if any, between the comprehensiveness of services delivered by family medicine physicians and the total spending of their patients.  (Annals Article)   The study population was fee-for-service Medicare beneficiaries who were treated by several thousand family medicine physicians.  The comprehensive of care delivered by these doctors was measured on two different scales, one based on a self-reported services rendered by the physicians and on based on a recoding of claims submitted by the doctors.  The primary outcome measures were rates of inpatient hospitalization, total Part A and Part B spending and Part B spending alone.

By the self-reported comprehensiveness of service scale, there was little association between comprehensiveness and rate of hospitalization, but by the recoded claims measure, a significant reduction in the likelihood of being hospitalized was associated with seeing a doctor offering more comprehensive services.  On both scales, patients seeing doctors with ratings in the top quintile of comprehensiveness had at least 10% lower total spending than those treated by physicians in the lowest quintile, and spending for Part B that was 13% lower.  Comprehensiveness presumably works to reduce spending by identifying potential health needs earlier and performing treatment in a less costly setting or manner.

One shortfall of the study is the limitations in how in measures comprehensiveness.  Comprehensiveness may not be how much of a patient’s total use of services is delivered by one physician, but more a result of how aware is the physician of all the patient’s health care needs; how often do they communicate with the patient about his or her health status; and is there a proactive plan to manage known conditions and to improve health status.  And not looking at the Medicare Advantage population ignores the segment of Medicare that has shown the most innovation and improvement in delivering primary care.