Primary care physicians that are part of large health systems lead to increased spending and specialist visits

In a Harvard study conducted in Massachusetts, researchers examined the consequences of relationships between primary care physicians and large health systems on health care utilization, spending, and patient outcomes. The study, which spanned from 2013 to 2017, aimed to uncover the impact of these relationships on various aspects of patient care.

The study was reported in JAMA Network.

Primary care costs more when doctors are affiliated with large health systems: ©ibreakstock - stock.adobe.com

Key Findings:

• Surge in Specialist Visits: The research revealed that vertical relationships between PCPs and health systems were correlated with a significant increase in specialist visits per patient-year. Compared to a control group, patients under the care of PCPs in these relationships saw a 22.64% rise in specialist visits, indicating a higher likelihood of receiving specialized care within the associated health systems.
• Escalation in Medical Spending: Patients whose PCPs had established vertical relationships with large health systems experienced a notable uptick in total medical expenditures per patient-year. This translated to an increase of $356.67 per patient-year, representing a 6.26% surge in health care spending when compared to the control group.
• Hospitalizations and Emergency Visits: While there was a minor increase in emergency department visits within the health system of attributed PCPs, the overall number of hospitalizations remained relatively steady, with only a slight uptick in hospitalizations within the health system.
• Steady Readmission Rates: Notably, the study found no significant alterations in readmission rates or the utilization of hospitals with low readmission rates. This suggests that vertical relationships did not influence readmission outcomes for patients.

The study's findings shed light on the consequences of vertical relationships between PCPs and large health systems. Researchers noted the following implications:

Channeling Patients into Health Systems: PCP–health system vertical relationships were linked to a practice known as "steering," where patients are directed toward receiving care within the affiliated health systems. This could impact patients' choices and potentially limit their options for care.

Increased Healthcare Spending: The study indicated that these vertical relationships resulted in higher spending on patient care. However, it did not provide evidence of improved patient outcomes or reduced readmissions.

Specialist Visits: The rise in specialist visits within health systems may have both positive and negative implications. On the one hand, it may offer improved access to specialized care. On the other hand, it raises concerns about overutilization and unnecessary visits.

According to the researchers, while these PCP-health system relationships may offer advantages, such as enhanced care coordination and access to specialists, they also present challenges related to increased spending and potential limitations on patient choice. They recommend that policymakers and health care stakeholders carefully consider strategies to mitigate the adverse effects of vertical consolidation on health care costs and access.