Costs Lower for Medicare Patients Who See Primary Care Physicians

June 15th, 2017

LEBANON, NH — Older patients who see primary care physicians (PCP) make fewer doctor visits, aren’t as likely to end up in the hospital, and cost the Medicare system less than those who use a specialist as their main ambulatory care provider.

While the health outcomes tend to be similar, a study published in the Journal of the American Geriatrics Association said that Medicare beneficiaries using PCPs as gatekeepers had greater continuity of care, which helped control expenses.

Unlike some health maintenance organizations that require PCP referral to specialists, traditional Medicare allows beneficiaries to see a specialist without a referral.

Researchers from Dartmouth’s Geisel School of Medicine, and colleagues focused on Medicare beneficiaries with more than one comorbid condition from 2011-12. They compared one-year mortality, hospitalization, standardized expenditures, and ambulatory visit patterns based on whether the patients had a PCP or specialist as their predominant provider of care (PPC).

Results indicate that two-thirds of the nearly 4 million beneficiaries with multi-morbidity had PCPs as their primary healthcare providers. Those with specialists serving that role had more hospitalizations (an additional 40.3 per 1,000) and higher spending ($1,781 more per beneficiary) than those who saw a PCP.

The observational study using propensity score matching identified little difference in mortality (0.2% higher) or preventable hospitalizations. The biggest cost difference was professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary), and outpatient facilities ($510 higher per beneficiary).

The patients with a specialist PPC also had lower continuity of care and saw more healthcare professionals.

“For older adults with multiple chronic conditions, having a specialist as a PPC is common (32% of people). Individuals who used a primary care provider as the clinician they saw most in the ambulatory setting had similar clinical outcomes as measured by potentially preventable hospitalizations and mortality, with a slightly favorable difference of 0.2% on a baseline mortality of approximately 10%,” study authors concluded. “Medicare expenditures, however, were higher when the PPC was a specialist, due largely to use of visits, tests, and imaging, but also higher risk of hospitalization. If the $1,800 per-beneficiary spending difference were applied to all 4 million Medicare fee-for-service beneficiaries in the community with multiple conditions, it would translate to $7 billion annually.”