PCMH model slowed growth in ED visits but had no effect on hospitalizations

Patient-centered medical homes (PCMHs) showed slower growth in expenditures for outpatient ED visits than non-PCMH practices, but the model wasn't associated with any decrease in hospitalizations, a recent study found.

Researchers analyzed a sample of Medicare beneficiaries treated at U.S. primary care practices from 2008 to 2010: 308 practices that were designated as PCMHs by the National Committee for Quality Assurance and 1,906 that weren't. At baseline, even before designation, the practices that would become PCMHs had healthier patients and lower ED and hospitalization costs and utilization, noted the authors, who adjusted for this variation in their analysis. Results were published by Annals of Emergency Medicine on March 10.

The practices that became PCMHs by 2009 had $54 less growth in their ED expenditures per patient than the non-PCMHs between 2008 and 2010, and the practices that became PCMHs in 2010 reduced growth by $48 during the time period compared to the non-PCMHs. Both differences were statistically significant. The PCMH practices also had slower growth in their ED visits per beneficiary, both for conditions that were judged ambulatory-care-sensitive and overall.

However, rates and costs of hospitalizations were not significantly affected by whether practices were PCMHs, the study found. These findings—both the lack of difference in hospitalization and the reduction in ED visit growth regardless of whether the condition was judged sensitive to ambulatory care—suggest that the PCMH model may substitute for some outpatient ED care, perhaps by expanding access, the authors wrote. “By comparison, becoming a patient-centered medical home did not appear to prevent more costly hospitalizations through improved communication, information sharing, and care coordination,” they added.

The study authors called for additional research into the effects of PCMH, especially on specific populations such as those with multiple comorbidities or social issues. An accompanying editorial suggested a rethinking of whole concept that outpatient care can and should prevent ED use to reduce health care costs. The study didn't determine whether the ED savings exceeded the costs of PCMH care, providing net savings, the editorialist noted. Reducing the more costly issue of ED visits that lead to admissions may prove more difficult, she said, concluding “perhaps policymakers should consider that the provision of acute, ‘outpatient’ type care in EDs may not be an anathema after all.”