Losing a primary care physician led to more use of specialty, urgent, and ED care
A study of health care utilization by Medicare beneficiaries whose primary care physicians left practice found increased spending, particularly among those who had been treated at a solo practice.
Loss of a primary care physician was associated with less primary care use and increased use of specialty, urgent, and emergency care among Medicare beneficiaries, a study found.
Researchers used nationally representative billing claims for a random sample of 359,470 Medicare fee-for-service beneficiaries with at least one primary care visit from January 2008 through December 2017 to examine changes in health care use and outcomes among patients whose primary care physician left the workforce. They then assessed the association of the turnover with patients' health care use and outcomes.
Primary care physicians who stopped practicing were matched with those who remained in practice. A difference-in-differences analysis compared health care use and clinical outcomes for patients who lost physicians with those who did not using subgroup analyses by practice size. Primary outcomes included primary care, specialty care, urgent care, ED visits, and inpatient visits, as well as overall patient spending. Researchers also looked at appropriate preventive care and prescription fills. Results were published Nov. 16 by JAMA Internal Medicine.
A total of 9,491 of 90,953 physicians (10.4%) exited Medicare during the study period. Researchers matched 169,870 beneficiaries whose physician exited with 189,600 beneficiaries whose physician did not exit. The year after physician exit, beneficiaries whose physician exited had 18.4% (95% CI, −19.8% to −16.9%) fewer primary care visits and 6.2% (95% CI, 5.4% to 7.0%) more specialty care visits versus beneficiaries who did not lose a physician.
In addition, beneficiaries whose physician exited had 17.8% (95% CI, 6.0% to 29.7%) more urgent care visits, 3.1% (95% CI, 1.6% to 4.6%) more ED visits, and greater spending ($189; 95% CI, $30 to $347) per beneficiary-year afterward. These shifts were most pronounced for patients of exiting physicians in solo practice; beneficiaries in these cases had 21.5% (95% CI, −23.8% to −19.3%) fewer primary care visits, 8.8% (95% CI, 7.6% to 10.0%) more specialty care visits, 4.4% more ED visits (95% CI, 2.1% to 6.7%), and $260 (95% CI, $12 to $509) more spending. The shift in care settings persisted at two years after physician exit.
The researchers acknowledged that findings may not be generalizable outside of Medicare populations and that the reason for a physician's exit, which was not tracked, may be associated with patient outcomes. They wrote, “Given that 10.4% of [primary care physicians] exited the workforce during the 4 years in our study sample, this trend could be associated with a meaningful shift away from primary care over a period of 2 to 3 decades.”