Abstract
Background
Broader primary care practice range of services (ROS), defined as the diversity of professional services delivered, is associated with lower utilization. ROS provided by individual primary care physicians (PCPs) varies considerably with unclear implications for patients.
Objectives
Create a PCP-ROS measure covering six categories of outpatient services, including expanded codes for mental health counseling services and point of care ultrasound (POCUS) technology in physician offices. Determine whether PCP-ROS is associated with total Medicare expenditures, inpatient admissions, acute hospital utilization (AHU), and emergency department (ED) visits. Examine physician and practice characteristics associated with PCP-ROS.
Design
Retrospective cohort study.
Participants
4,569,711 Medicare fee-for-service beneficiaries and 27,008 PCPs observed during the evaluation of the Comprehensive Primary Care Plus (CPC +) initiative.
Measurements
PCP-ROS, hospitalizations, AHU (includes observation stays as well as inpatient admissions), ED visits, and total Medicare expenditures.
Results
Physicians varied substantially in the range of services provided. Broader PCP-ROS was significantly, independently associated with 1 – 3% lower Medicare expenditures (p ≤ 0.01), inpatient admissions (p ≤ 0.027), AHU (p ≤ 0.025), and ED visit rates (p ≤ 0.000). PCP-ROS score was associated with improved patient outcomes, independent of physician provision of procedures (such as laceration repair or skin excisions). Physicians in practice sites affiliated with a hospital or health system had narrower PCP-ROS than independent physicians by 0.3 to 0.4 (p < 0.001). Internal medicine specialty was associated with narrower PCP-ROS than family medicine by 0.3 (p < 0.001).
Conclusions
Patients cared for by primary care physicians who provide a broader range of services subsequently experience lower acute care utilization and expenditures than do those cared for by physicians with narrower ROS. Practice leaders and professional associations should consider how best to ensure that primary care physicians efficiently and effectively provide the office-based professional services most needed by their patients.
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Acknowledgements:
The authors would like to thank Dmitriy Poznyak, PhD, at Mathematica for his assistance with reliability testing of our Practice-ROS measure, as well as Nancy McCall, ScD, at Mathematica for their thoughtful advice throughout this research and careful review of this manuscript.
Funding
Supported by the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, under contracts HHSM-500–2014-00034I/HHSM-500-T0010 and HHSM-500–2014-00034I/75FCMC19F0005.
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Conflict of Interest:
The authors declare that they do not have any conflict of interest aside from support on contracts from Centers for Medicare & Medicaid Services (CMS) during the conduct of the study.
IRB Approval:
The New England Institutional Review Board (IRB) granted the initiative an IRB exemption on the basis of the federal common rule (Section 45 CFR 46.101[b][5]), because the purpose of the study was to evaluate a public benefit program.
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Rich, E., Peris, K., Luhr, M. et al. Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization. J GEN INTERN MED 38, 3414–3423 (2023). https://doi.org/10.1007/s11606-023-08363-5
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DOI: https://doi.org/10.1007/s11606-023-08363-5