New approaches to measuring the comprehensiveness of primary care physicians

Abstract

Objective To develop claims‐based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting A total of 5359 PCPs caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices. Study Design We developed Medicare claims‐based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings Each measure varied across PCPs and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose PCPs’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.

Comparing Comprehensiveness in Primary Care Specialties and Their Effects on Healthcare Costs and Hospitalizations in Medicare Beneficiaries

“…Additionally, alternative measures such as "new problem management" and "involvement in patient conditions" described by O'Malley and Rich could further capture comprehensiveness with more reliability. 5 Future research should use other source data and study additional populations, as well as focus on which specific BETOS codes are associated with lower healthcare costs, fewer hospitalizations, and other policy-relevant outcomes.…”

Using Medicare data to measure vertical integration of hospitals and physicians

“…Hospitals report their employment or other contractual relationships with physicians in the American Hospital Association (AHA) annual survey. The survey data has been used in studies to categorize hospitals by physician-hospital affiliation status based on their responses to the arrangements the hospital has with physicians (Baker et al 2016;Ciliberto and Dranove 2006;Cuellar and Gertler 2006;Madison 2004;Scott et al 2017;Short and Ho 2019). However, the AHA data do not provide information on which physicians each hospital has contractual relations with.…”

“…The MD-PPAS reports the National Provider Identifier, the two most common tax identification numbers (TINs), and legal names used by each physician when filing claims with the Medicare program. The data has been used in previous analyses of physician markets, but not for studies of vertical integration (O'Malley et al 2019;Studdert et al 2019;Welch et al 2014). While it is plausible that physicians with a hospital affiliation would submit both Medicare and private insurance claims under that same hospital, we know of no studies that have verified this behavior.…”

Which procedures are performed by general internists practicing primary care in Germany? - a cross-sectional study

“…The World Health Organization (WHO) described distinctive features of primary care as person-centeredness, continuity, comprehensiveness and integration. All of these aspects contribute to quality of care and better outcomes [1][2][3].…”