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

Andrew Bazemore, Stephen Petterson, Lars E Peterson, Richard Bruno, Yoonkyung Chung, Robert L Phillips Jr 


Purpose: 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.

Methods: 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 & B expenditures (allowed charges, logged), and any hospitalization.

Results: 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).

Conclusions: 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.

This article was featured in the October 7, 2021, Lunch and Learn discussion

In this segment of the October Lunch and Learn discussion, Andrew Bazemore, Senior Vice President of Research and Policy at the American Board of Family Medicine; and Stephen Petterson, former Research Director at the Robert Graham Center presented the article.

Summary of Discussion Highlights:

  • Physicians with the highest level of continuity were associated with declines in total expenditures and hospitalizations. The value associated with a 14% reduction in costs is roughly $1,000/beneficiary/year.
  • Both individual physician- and practice-level continuity are important dimensions of primary care measurement.
  • Non-physician clinicians are essential to establishing continuity as part of the primary care team.
  • Physician continuity should continue to be measured and rewarded (e.g., Medicare’s Quality Payment Program).
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