Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations

TLDR

Continuity of care is a core primary‑care attribute linked to lower costs and better quality, yet provider‑level continuity metrics suitable for value‑based payment programs are not yet available. The study developed four physician‑level, claims‑based continuity measures and examined their relationships with Medicare expenditures and hospitalizations. Using Medicare claims for 1.45 million beneficiaries seen by 6,551 primary‑care physicians, the authors calculated physician‑level continuity scores from four established methods, averaged patient scores, and applied multilevel models controlling for beneficiary and physician characteristics to estimate associations with Part A & B expenditures and hospitalization risk. Higher continuity scores were strongly correlated and associated with 14.1 % lower adjusted expenditures and 16.1 % lower odds of hospitalization, indicating that all four measures predict reduced costs and utilization and could serve as QPP metrics.

Abstract

<h3>PURPOSE</h3> Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations. <h3>METHODS</h3> We used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A &amp; B expenditures (allowed charges, logged), and any hospitalization. <h3>RESULTS</h3> Our continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = –0.151; 95% CI, –0.186 to –0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893). <h3>CONCLUSIONS</h3> All 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.