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Comprehensive Primary Care Better for Patients, Medicare’s Costs

WASHINGTON, DC –Primary care physicians who take on more of the overall care of their patients not only improve health outcomes but also save federal dollars in doing so.

That’s according to a new report published in the Annals of Family Medicine. The authors, led by Andrew W. Bazemore, MD, MPH, of the Robert Graham Center in Washington, DC, suggest, “Payment and practice policies that enhance primary care comprehensiveness may help ‘bend the cost curve.’”

Comprehensiveness, defined as the provision of care across a broad spectrum of health problems, age ranges, and treatment modalities, is one of the five core virtues of primary care, and usually encompasses prevention and wellness, acute care, chronic care, and managing multiple conditions. Yet, the study notes, the relationship between comprehensiveness and better outcomes has been unclear.

To remedy that, the authors sought to measure associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries.

For the study, the researchers used Medicare Part A and B data from 1,133 family physicians, who recertified between 2007 and 2011 and cared for 185,044 Medicare beneficiaries. The study team created a measure of comprehensiveness from self-reported information required for examination registration and compared it to another derived from Medicare’s Berenson-Eggers Type of Service (BETOS) codes. They then examined how comprehensiveness was associated with hospitalizations, Part B payments, and combined Part A and B payments.

Results indicate that, 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,” the authors explain.

“This evidence arrives at a critical juncture for family medicine,” according to the authors, who cite a 2004 declaration by seven national family medicine organizations that the future of family medicine required a “commitment to provide patients with family medicine’s full basket of services – either directly or indirectly.”

Providing more comprehensiveness in primary care is not without challenges, however.

“Since the Future of Family Medicine report, however,” they add, “family physicians are being asked to acquire and employ new skills in greater population health management, administration and leadership of teams, and informatics – all this while caring for an aging and increasingly multi-morbid pool of patients.”