Variation in Specialty Outpatient Care Patterns in the Medicare Population.
J Gen Intern Med
; 31(11): 1278-1286, 2016 11.
Article
em En
| MEDLINE
| ID: mdl-27259290
ABSTRACT
BACKGROUND:
Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care.OBJECTIVE:
To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status.DESIGN:
Retrospective cross-sectional study. PATIENTS A 20 % random sample of Medicare fee-for-service beneficiaries in 2012. MAINMEASURES:
Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses. KEYRESULTS:
The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]).CONCLUSIONS:
Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Medicare
/
Satisfação do Paciente
/
Gastos em Saúde
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Assistência Ambulatorial
/
Medicina
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Aspecto:
Patient_preference
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Assunto da revista:
MEDICINA INTERNA
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Estados Unidos