Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
- Physicians varied substantially in the range of services provided.
- Broader PCP-Range of Services was significantly, independently associated with 1–3 percent lower Medicare expenditures (p ≤ 0.01), inpatient admissions (p ≤ 0.027), acute hospital utilization (p ≤ 0.025), and emergency department visit rates (p ≤ 0.000).
- PCP-Range of Services 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-Range of Services than independent physicians by 0.3 to 0.4 (p<0.001).
- Internal medicine specialty was associated with narrower PCP-Range of Services than family medicine by 0.3 (p<0.001).
Comprehensiveness is a core component of primary care, defined as the extent to which a patient’s primary care provider (PCP) recognizes and meets most of their patient’s physical and common mental health care needs. Despite the simplicity of this concept, comprehensiveness invokes several dimensions, including the depth and breadth of conditions managed (i.e., “involvement in patient conditions”), and the extent to which the primary care practitioner can effectively address new problems (“new problem management”) as well as the “range of services” provided.
In this paper, we created an individual PCP-Range of Services measure, assessed its reliability, and investigated whether the range of outpatient primary care services provided by individual PCPs is associated with patient outcomes. We also identify physician and practice characteristics that are associated with variations in the range of service provided by PCPs.
Results indicate that 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 range of services. 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.