More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations

Abstract

Purpose: Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries.

Methods: We merged data from 2011 Medicare Part A and B claims files for a complex random sample of family physicians engaged in direct patient care, including 100% of their claimed care of Medicare beneficiaries, with data reported by the same physicians during their participation in Maintenance of Certification for Family Physicians (MC-FP) between the years 2007 and 2011. We created a measure of comprehensiveness from mandatory self-reported survey items as part of MC-FP examination registration. We compared this measure to another derived from Medicare's Berenson-Eggers Type of Service (BETOS) codes. We then examined the association between the 2 measures of comprehensiveness and hospitalizations, Part B payments, and combined Part A and B payments.

Results: Our full family physician sample consists of 3,652 physicians providing the plurality of care to 555,165 Medicare beneficiaries. Of these, 1,133 recertified between 2007 and 2011 and cared for 185,044 beneficiaries. There was a modest correlation (0.30) between the BETOS and self-reported comprehensiveness measures. After adjusting for beneficiary and physician characteristics, increasing comprehensiveness was associated with lower total Medicare Part A and B costs and Part B costs alone, but not with hospitalizations; the association with spending was stronger for the BETOS measure than for the self-reported measure; higher BETOS scores significantly reduced the likelihood of a hospitalization.

Conclusions: Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help "bend the cost curve."

Keywords: comprehensive health care; cost analysis; family medicine; general practice.

Figure 1

Association between comprehensiveness score and measures of hospitalization and expenses. ln = natural logarithm; OR = Odds ratio. 2011 Medicare Claims Data; Sample consists of recertifying family physicians, n = 1,133. Estimates of percent change and odds ratio are adjusted for patient and physician characteristics; full model in Supplemental Appendix 1, http://www.annfammed.org/content/13/3/206/suppl/DC1.

Figure 2

Association between BETOS score and measures of hospitalization and expenses. BETOS = Berenson-Eggars Type of Service; ln = natural logarithm; OR = odds ratio. 2011 Medicare Claims Data; Sample consists of the full sample of family physicians (n = 3,660). Estimates of percent change and odds ratio are adjusted for patient and physician characteristics; full model in Supplemental Appendix 1, http://www.annfammed.org/content/13/3/206/suppl/DC1.