Comparative Costs of Sources of Usual Care

For most Americans their usual source of health care is a primary care clinician or practice, although a significant segment of the population seems to use ERs, urgent care centers and retail clinics for that purpose.  A statistical brief from the Agency for Healthcare Research & Quality examines costs and other features of differing sources of usual care.  (AHRQ Brief)   In 2015 and 2016, when the data for the brief was collected, about 76% of the US population had a usual source of care.  Of this 76%, 61% saw their usual source of care provider at least once a year.  So only about 43% of Americans see a usual source of care provider once a year.  The average cost for a visit in 2016 was $150.  It was lowest for a solo practice, at $112, $130 in a practice with 2-3 doctors, $159 for practices with 4 to 10 physicians and $183 for a practice with 11 or more physicians.  So explain to me again how it is to our benefit that we allow all this consolidation of physician practices?  And I am quite sure there is little difference in quality among these practice sizes.

Interestingly, practices with two or more nurse practitioners and /or physician assistants had a higher average per visit expense, at $162, than did those with only one at $128.  This likely is due to an interaction with the larger practice factor.  Practices with a case manager on staff to coordinate care also had higher per visit cost, $169, than those without, $127.  The average cost for an independent doctor visit was $139, versus a physician-owned network at $159, and a government or non-profit clinic, $154.  Practices with EHRs had an average higher cost, $153, than those without one, $116.  If the practices had x-ray on site, visit average was $173 versus $136 for practices without this capability.  If you have those machines you might as well use them and bill it out.  All of these variables suggest that there is no scale factor that lowers cost, quite the contrary, the larger the practice the more it charges.  And I suspect some of this is due to larger practices having greater market power.