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Variation in Specialty Outpatient Care Patterns in the Medicare Population.

Abstract：

BACKGROUND:Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. OBJECTIVE:To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status. DESIGN:Retrospective cross-sectional study. PATIENTS:A 20 % random sample of Medicare fee-for-service beneficiaries in 2012. MAIN MEASURES:Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses. KEY RESULTS:The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]). CONCLUSIONS:Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Clough JD,Patel K,Shrank WH

doi

10.1007/s11606-016-3745-8

subject

Has Abstract

pub_date

2016-11-01 00:00:00

pages

1278-1286

issue

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-016-3745-8

journal_volume

pub_type

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Variation in Specialty Outpatient Care Patterns in the Medicare Population.