News & Commentary

Comprehensiveness of Care Cuts Cost


Medicare beneficiaries with primary care physicians (PCPs) who are less likely to refer them to specialists (that is, the PCPs provide more comprehensive care) are 35% less likely to be hospitalized, according to a study published in the Annals of Family Medicine.

The issue is: What difference does it make when patients see PCPs who offer more comprehensive care, as defined by the American Board of Family Medicine?

Answer: A lot. Costs for patients offered more comprehensive primary care were 10% to 13% less. “Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations,” the study states.

Comprehensive care varied greatly, depending on the procedure. For instance, 63% of PCPs cared for newborns while, at the other end of the scale, 2% performed major surgery. Other activities included minor office surgery (61.4%), pain management (46.4%), and palliative care (25.9%).

Researchers with the Robert Graham Center in Washington analyzed claims data from about 3,600 family physicians that contain information about hospitalizations and total costs for about 555,000 Medicare beneficiaries.

Traditionally, primary care services have encompassed care for all kinds of patients and medical problems and has included inpatient and outpatient care, obstetrics, pediatrics, geriatrics, and even minor surgery. The challenge of providing this kind of all-comers care can be daunting, requiring primary care physicians to work in multiple settings and deal with the increasing complexity of chronic care.

But the general scope of care provided by family physicians has been shrinking, the Graham Center authors note. At the same time, they add, “family physicians are being asked to acquire and employ new skills in greater population health management, administration and leadership teams, and informatics—all this while caring for an aging and increasingly multimorbid pool of patients.”