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.
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↵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.
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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.
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- 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.
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BETOS = Berenson-Eggers Type of Service codes.
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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.
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↵a P <.0 5.
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↵b P <. 01.
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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.
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