Emergency department and inpatient hospital use by Medicare beneficiaries in patient-centered medical homes

Abstract

Study objective: Patient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED visits and hospitalizations (all-cause and ambulatory-care-sensitive conditions) between patient-centered medical homes recognized in 2009 or 2010 and practices without recognition.

Methods: We studied a sample of US primary care practices and federally qualified health centers: 308 with and 1,906 without patient-centered medical home recognition, using fiscal year 2008 to 2010 Medicare fee-for-service data. We assessed average annual practice-level payments per beneficiary for ED visits and hospitalizations and rates of ED visits and hospitalizations (overall and ambulatory-care-sensitive condition) per 100 beneficiaries before and after patient-centered medical home recognition, using a difference-in-differences regression model comparing patient-centered medical homes and propensity-matched non-patient-centered medical homes.

Results: Comparing patient-centered medical home with non-patient-centered medical home practices, the rate of growth in ED payments per beneficiary was $54 less for 2009 patient-centered medical homes and $48 less for 2010 patient-centered medical homes relative to non-patient-centered medical home practices. The rate of growth in all-cause and ambulatory-care-sensitive condition ED visits per 100 beneficiaries was 13 and 8 visits fewer for 2009 patient-centered medical homes and 12 and 7 visits fewer for 2010 patient-centered medical homes, respectively. There was no hospitalization effect.

Conclusion: From 2008 to 2010, outpatient ED visits increased more slowly for Medicare patients being treated by patient-centered medical home practices than comparison non-patient-centered medical homes. The reduction was in visits for both ambulatory-care-sensitive and non-ambulatory-care-sensitive conditions, suggesting that steps taken by practices to attain patient-centered medical home recognition such as improving care access may decrease some of the demand for outpatient ED care.