Extended Office Hours and Health Care Expenditures: A National Study

Anthony Jerant; Klea D. Bertakis; Joshua J. Fenton; Peter Franks

doi:10.1370/afm.1382

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More proof of the value of accessible primary care
Erika B Bliss, MD

Published on: 15 October 2012
Achieving quality of care at a lower cost
Thomas C. Rosenthal

Published on: 18 September 2012
The Joys of "second shift"
Kurtis S Elward

Published on: 12 September 2012

Published on: (15 October 2012)
Page navigation anchor for More proof of the value of accessible primary care
More proof of the value of accessible primary care
Erika B Bliss, MD, CEO
This is a very important piece of research that starts to drill down on which precise characteristics of outpatient primary care contribute to better outcomes and lower costs. It makes intuitive sense that having better access to primary care, not just in terms of getting in the same day, but getting in at a time when you need it, would obviate the need for use of more expensive or less ideal care and services. In our e...
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This is a very important piece of research that starts to drill down on which precise characteristics of outpatient primary care contribute to better outcomes and lower costs. It makes intuitive sense that having better access to primary care, not just in terms of getting in the same day, but getting in at a time when you need it, would obviate the need for use of more expensive or less ideal care and services. In our experience at Qliance, which is a direct primary care practice (smaller patient panels, longer appointment slots, extended weekday and weekend hours, direct access to a practice physician by phone after hours, phone and email access to your physician during regular hours), costs can be driven down even further, we estimate by about the same 30% that is being shown by the IOM and others to be waste in the system. So everywhere we turn, accessible primary care in whatever form it takes is demonstrating that it is a simple, inexpensive, and elegant solution to what ails our healthcare system. Thankfully, employers, trusts, and other large purchasers of healthcare, along with major carriers, are starting to understand its value. Hopefully, this trend will continue.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (18 September 2012)
Page navigation anchor for Achieving quality of care at a lower cost
Achieving quality of care at a lower cost
Thomas C. Rosenthal, Professor and Chair, Dept of Family Medicine
I felt that the Jerant paper was an important contribution. I am chairing a new physician network as a joint venture with a large hospital system and a payer. To be successful we must reduce premiums a minimum of 10%. The literature has pretty well documented a 30% margin of health care expenditures that are duplicative or unnecessary. However, the bits and pieces within the system that can contribute to achieving quali...
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I felt that the Jerant paper was an important contribution. I am chairing a new physician network as a joint venture with a large hospital system and a payer. To be successful we must reduce premiums a minimum of 10%. The literature has pretty well documented a 30% margin of health care expenditures that are duplicative or unnecessary. However, the bits and pieces within the system that can contribute to achieving quality of care at a lower cost are not well studied. It is unlikely that merely setting outcome standards will achieve our goals. We must better understand the components of care that lead to better health. It is quite simple to say that access in a primary care office meets the CMS triple aim of better health, better care and lower costs. Extended hours can be implemented without redoing job descriptions or hiring a programmer to improve the EMR. Thank you Dr Jerant and colleagues for elucidating another piece of the puzzle.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (12 September 2012)
Page navigation anchor for The Joys of "second shift"
The Joys of "second shift"
Kurtis S Elward, Physician
I applaud the authors on establishing the benefits of after hours care, which is a key to lowering health care costs. The data they present is important information.
At the same time, I wonder whether these data in any way could make the case for an increase the reimbursements/copays for primary care afterhours care. For example, consider a patient copay of $75-$100 which is 1/3 of what our local insurers char...
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I applaud the authors on establishing the benefits of after hours care, which is a key to lowering health care costs. The data they present is important information.
At the same time, I wonder whether these data in any way could make the case for an increase the reimbursements/copays for primary care afterhours care. For example, consider a patient copay of $75-$100 which is 1/3 of what our local insurers charge their members for ER copays. (no extra cost to the insurers, as it would be a copay). The insurers, patients and their family physician would win in the process. Could the authors evaluate their data and the savings based on higher copays to PCPs for afterhours care?
Currently, at the going rate of a mere $16 extra for an after hours visit, I an not sure I want to work first AND second shifts, never see my wife, and miss my kids' lives while I am helping "the system" out.
Competing interests: None declared
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Competing Interests: None declared.