Article Figures & Data
Figures
- Figure 1
Association between comprehensiveness score and measures of hospitalization and expenses.
ln = natural logarithm; OR = Odds ratio.
2011 Medicare Claims Data; Sample consists of recertifying family physicians, n = 1,133.
Estimates of percent change and odds ratio are adjusted for patient and physician characteristics; full model in Supplemental Appendix 1, http://www.annfammed.org/content/13/3/206/suppl/DC1.
- Figure 2
Association between BETOS score and measures of hospitalization and expenses.
BETOS = Berenson-Eggars Type of Service; ln = natural logarithm; OR = odds ratio.
2011 Medicare Claims Data; Sample consists of the full sample of family physicians (n = 3,660).
Estimates of percent change and odds ratio are adjusted for patient and physician characteristics; full model in Supplemental Appendix 1, http://www.annfammed.org/content/13/3/206/suppl/DC1.
Tables
- Table 1
Percentages of Family Physicians Providing Select Services, ABFM Activities, and BETOS Codes
Indicator %a ABFM comprehensiveness activities (n=1,133 family physicians) Newborn care 63.0 Minor office surgery 61.4 Pain management 46.4 Preoperative care 39.4 Urgent care 39.2 Palliative care 25.9 Emergency care 23.9 Postoperative care 17.3 Prenatal care 13.9 Maternity care 9.9 Any deliveries 9.3 Major surgery 2.0 BETOS Codes (n=3,652 family physicians) Evaluation and management Office visits, established 95.9 Office visits, new 90.8 Specialist, other 79.6 Hospital visit, subsequent 40.1 Hospital visit, initial 39.7 Nursing home visit 36.7 Home visit 14.0 Hospital visit, critical care 12.6 Emergency department visit 11.7 Procedures Minor procedures, other (Medicare fee schedule) 92.6 Minor procedures, skin 78.6 Ambulatory procedures, skin 68.6 Minor procedures, musculoskeletal 64.5 Ambulatory procedures, other 11.0 Endoscopy, other 9.6 Major procedure, other 6.2 Eye procedure, other 5.0 Ambulatory procedures, musculoskeletal 3.8 Endoscopy, colonoscopy 3.6 Oncology, other 3.3 Endoscopy, upper gastrointestinal 2.8 Major procedure, orthopedic, other 2.4 Major procedure, cardiovascular, other 2.3 Minor procedures, other (non-Medicare fee schedule) 1.9 Endoscopy, sigmoidoscopy 1.2 Technical services Other tests, electrocardiograms 85.8 Lab tests, urinalysis 77.9 Lab tests, other (non-Medicare fee schedule) 77.2 Other tests, other 72.8 Lab tests, routine venipuncture (non Medicare fee schedule) 61.8 Lab tests, glucose 51.6 Lab tests, other (Medicare fee schedule) 50.0 Lab tests, blood counts 39.1 Other tests, ECG monitoring 32.1 Lab tests, automated general profiles 27.3 Lab tests, bacterial cultures 16.0 Other tests, cardiovascular stress tests 7.5 -
BETOS = Berenson-Eggers Type of Service; ABFM = American Board of Family Medicine.
-
↵a Percentages of family physicians who indicated that they devoted any time to a particular activity in the case of the ABFM items or billed Medicare at least once for each type of BETOS service, procedure, or test.
-
All Family Physicians Recertifying Family Physicians Physicians (No.) 3,652 1,133 Patients (No.) 555,165 185,044 Patient characteristics Female 60.1% 61.0% Race/ethnicity White 83.7% 85.9% Black 7.1% 5.6% Hispanic 5.6% 4.7% Other race 3.7% 3.8% Age (mean) 75.0 75.0 Weighted Charlson score (mean) 1.25 1.23 Primary care visits 6.04 6.08 Physician characterisitics Location Urban 75.6% 76.8% Large rural 14.0% 13.7% Small rural 6.0% 6.2% Isolated rural 2.1% 2.1% Frontier 1.8% 1.0% Years since graduation (mean) 23.1 23.1 International medical school graduate 14.0% 11.1% Patients (mean) 197.0 208.0 Female 28.3% 30.9% % Care in hospital 7.3% 7.8% -
Medicare claims data, 2011.
-
- Table 3
Variation in Comprehensiveness and BETOS Scores Across Selected Characteristics of Family Physicians
Comprehensiveness Scores Recertifying Family Physicians BETOS Scores Full Sample of Family Physicians Medical School Location United States 3.51 1042 13.86a 3,257 International 3.12 91 12.27 395 Sex Male 3.46 771 14.04a 2,549 Female 3.49 362 12.60 1,103 Medical school type Allopathic 3.42 1048 13.73a 3,052 Osteopathic 4.22 85 13.20 600 Year of medical school graduation <1980 2.81b 211 13.53 731 1980–1989 3.57 340 13.69 1,111 1990–1999 3.66 571 13.68 1,302 ≥2000 3.86 11 13.57 508 Practice location Urban 3.27b 760 13.44a 2,421 Large rural 3.71 214 13.92 673 Small rural 4.65 91 14.71 290 Isolated rural 4.77 45 14.41 158 Frontier 5.60 22 16.29 89 Family physicians per 100,000 population 0–20 2.44b 48 12.64a 151 21–40 3.37 717 13.59 2,325 41+ 4.25 368 14.15 1,176 -
Medicare Claims Data, 2011.
-
BETOS = Berenson-Eggers Type of Service codes.
-
Note: The mean comprehensiveness scores are based on the subsample of recertifying family physicians (n=1,133). Comprehensiveness scores for individual physicians range from 0 to 12. The mean BETOS scores are based on the full sample of family physicians (n=3,652). BETOS scores range from 1 to 32.
-
↵a P <.0 5.
-
↵b P <. 01.
-
Supplemental Appendixes 1-2
Supplemental Appendixes
Files in this Data Supplement:
The Article in Brief
More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations
Andrew Bazemore , and colleagues
Background Comprehensiveness is considered one of the five core virtues of primary care, but its effect on health care utilization and costs is unclear. Given considerable advances in health care technology, our aging and more insured population, and significant variation and decreasing scope of practice by family physicians, this study examines whether comprehensiveness has a positive effect on costs. In particular, it evaluates the relationship between individual family physicians' comprehensiveness and hospitalization rates and total costs among their Medicare beneficiaries.
What This Study Found More comprehensive scope of practice is associated with significantly lower Medicare expenditures per beneficiary and fewer hospitalizations. Specifically, patients of family physicians who performed and billed for a broader range of services had 10 to 15 percent lower costs when compared to the least comprehensive physicians.
Implications
- Comprehensiveness in family medicine is both measurable and important.
- Absent this important evidence, the authors warn, there is real risk of continued, unresisted erosion of family medicine's commitment to comprehensive care in the name of daily patient volume and efficiency.
- The authors assert that these study findings should encourage policy makers to consider training and payment policies that support more robust and comprehensive practices as one means of bending the cost curve and achieving the nation's Triple Aim. They call for further exploration of the measurement of comprehensiveness and its relationship to cost, access and quality of care.
In this issue
Jump to section
Related Articles
Cited By...
- Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022
- Factors Influencing Changing Scopes of Practice Among Contemporary Graduates of the Nations Largest Family Medicine Residency
- Regional Variation in Scope of Practice by Family Physicians
- Scope of practice of Japanese primary care physicians and its associated factors: a cross-sectional study
- Characteristics of family physicians with additional training or focused practices in caring for older adults: Population-based retrospective cohort study
- Storylines of family medicine IX: people and places--diverse populations and locations of care
- Storylines of family medicine III: core principles--primary care, systems and family
- Defining the capabilities and competencies of high-performing family physicians: a mixed methods study
- Changes in comprehensiveness of services delivered by Canadian family physicians: Analysis of population-based linked data in 4 provinces
- Reducing Acute Hospitalizations at High-Performing CPC+ Primary Care Practice Sites: Strategies, Activities, and Facilitators
- Time for Family Medicine to Stop Enabling a Dysfunctional Health Care System
- Health TAPESTRY Ontario: A Multi-Site Randomized Controlled Trial Testing Implementation and Reproducibility
- The Association of Practice Type and the Scope of Care of Family Physicians
- Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
- Pandemic Disruption in Residency Did Not Alter Trends in Intended Scope of Practice
- Pandemic Disruption in Residency Did Not Alter Trends in Intended Scope of Practice
- Does individual-socioeconomic variation in quality-of-primary care vary according to area-level service organisation? Multilevel analysis using linked data
- Intentionality Required to Equip a Diverse Physician Workforce with Tools and Infrastructure to Deliver Comprehensive Care
- Predictors of Primary Care Practice Among Medical Students at the Michigan State University College of Human Medicine
- Drivers of Scope of Practice in Family Medicine: A Conceptual Model
- The Growth of Family Medicine Resident Debt
- Clinical Redeployment of an Academic Family Medicine Department in an Early, Severe COVID-19 Pandemic in the Bronx, NY
- Developing measures to capture the true value of primary care
- Heeding the Call for Urgent Primary Care Payment Reform: What Do We Know about How to Get Started?
- Children as frequent attenders in primary care: a systematic review
- The Built Environment for Professionalism
- Primary Care Is an Essential Ingredient to a Successful Population Health Improvement Strategy
- The Declining Presence of Family Physicians in Hospital-Based Care
- IMPROVING QUALITY IMPROVEMENT
- NUMBERS MATTER
- Primary Care Physician Characteristics Associated with Low Value Care Spending
- The American Board of Family Medicine's Data Collection Method for Tracking Their Specialty
- Whats in a name?: Dr Ian McWhinney Lecture, 2018
- Practice Rurality of Family Physicians Enrolled in a Practice Transformation Network
- Higher Primary Care Physician Continuity is Associated With Lower Costs and Hospitalizations
- Comprehensive practice: Normative definition across 3 generations of alumni from a single family practice program, 1985 to 2012
- Response: Re: Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians
- How Evolving United States Payment Models Influence Primary Care and Its Impact on the Quadruple Aim
- Burnout and Scope of Practice in New Family Physicians
- Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians
- Potentially Alarming Trends in the Scope of Practice for Family Physicians
- Identification of physicians providing comprehensive primary care in Ontario: a retrospective analysis using linked administrative data
- The Chief Primary Care Medical Officer: Restoring Continuity
- The Challenges of Measuring, Improving, and Reporting Quality in Primary Care
- Fertility Treatment, Use of in Vitro Fertilization, and Time to Live Birth Based on Initial Provider Type
- The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice
- Regional Variation in Primary Care Involvement at the End of Life
- Legislating away the future of family practice: Dangerous transition from continuity of care to continuous access
- "A Paradox Persists When the Paradigm Is Wrong": Pisacano Scholars' Reflections from the Inaugural Starfield Summit
- Balayer lavenir de la pratique familiale par decret: Une transition dangereuse de la continuite des soins a la continuite de lacces
- Comprehensiveness of care
- Patient Relationships and the Personal Physician in Tomorrow's Health System: A Perspective from the Keystone IV Conference
- Where is family medicine heading?
- To Be or Not to Be Comprehensive
- In This Issue: A Cry for Balance