business

Expanded access to primary care linked to lower health costs

A study suggests that insurers save money when patients can be seen by doctors after-hours, and that physicians might need to expand their work schedules.

By — Posted Sept. 17, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Allowing patients evening and weekend appointments with their usual doctors when they need them, a key aspect of the patient-centered medical home, may reduce annual medical expenses, according to a study in the September/October Annals of Family Medicine.

“There’s lots of pressure for physicians to do this, and we did see an association between practices offering extended hours and lowered expenditures,” said Anthony Jerant, MD, lead author and professor in the Dept. of Family and Community Medicine at the University of California, Davis School of Medicine in Sacramento.

Several insurers pay primary care physicians to provide medical home services in hopes that such efforts will rein in escalating health care costs, and practices will need to decide if providing expanded access is worth it. Researchers say this does not necessarily mean hiring more physicians, but it may require doctors to rearrange schedules to offer greater availability when patients are off work. It also would reduce referrals to emergency departments, urgent care centers and retail clinics. A study in the June Journal of General Internal Medicine found that after-hours access to care was possible for many practices without a large budget.

To assess the impact of extended office hours, authors of the Annals of Family Medicine study analyzed publicly available data on 33,269 adult patients included in the Medical Expenditure Panel Surveys from 2000 to 2008, run by the Agency for Healthcare Research and Quality. A total of 21,817 participants could not receive care on evening and weekends from their usual physician, while 11,452 did have such access. The survey did not record the size of the medical practices where patient received care or why some patients did not have expanded access.

Annual total health expenditures for those with expanded access were $4,067, compared with $5,522 for patients without such access. Average totals for other kinds of care also were less for patients with expanded access: office-based care, $947 to $1,229; prescription drug costs, $894 to $1307; and emergency department use, $123 to $144.

Additional costs for practices to providing expanded-hours care were not reported, although they most likely would vary greatly, and evening and weekend hours were not defined.

The authors suspect that costs were lower because extended access led to more judicious use of health care resources. Patients able to visit their usual physicians rather than an emergency department, urgent care center or retail clinic presumably would receive fewer tests, prescriptions and other services. Extended hours also may be a marker of an efficient practice.

Back to top


External links

“After-Hours Care and its Coordination with Primary Care in the U.S.,” Journal of General Internal Medicine, June (link)

“Extended Office Hours and Health Care Expenditures: A National Study,” Annals of Family Medicine, September/October (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story