Expanded access to primary care linked to lower health costs

Allowing patients evening and weekend appointments with their usual doctors when they need them, a key aspect of the patient-centered medical home, may reduce annual medical expenses, according to a study in the September/October Annals of Family Medicine.

“There’s lots of pressure for physicians to do this, and we did see an association between practices offering extended hours and lowered expenditures,” said Anthony Jerant, MD, lead author and professor in the Dept. of Family and Community Medicine at the University of California, Davis School of Medicine in Sacramento.

Several insurers pay primary care physicians to provide medical home services in hopes that such efforts will rein in escalating health care costs, and practices will need to decide if providing expanded access is worth it. Researchers say this does not necessarily mean hiring more physicians, but it may require doctors to rearrange schedules to offer greater availability when patients are off work. It also would reduce referrals to emergency departments, urgent care centers and retail clinics. A study in the June Journal of General Internal Medicine found that after-hours access to care was possible for many practices without a large budget.

To assess the impact of extended office hours, authors of the Annals of Family Medicine study analyzed publicly available data on 33,269 adult patients included in the Medical Expenditure Panel Surveys from 2000 to 2008, run by the Agency for Healthcare Research and Quality. A total of 21,817 participants could not receive care on evening and weekends from their usual physician, while 11,452 did have such access. The survey did not record the size of the medical practices where patient received care or why some patients did not have expanded access.

Annual total health expenditures for those with expanded access were $4,067, compared with $5,522 for patients without such access. Average totals for other kinds of care also were less for patients with expanded access: office-based care, $947 to $1,229; prescription drug costs, $894 to $1307; and emergency department use, $123 to $144.

Additional costs for practices to providing expanded-hours care were not reported, although they most likely would vary greatly, and evening and weekend hours were not defined.

The authors suspect that costs were lower because extended access led to more judicious use of health care resources. Patients able to visit their usual physicians rather than an emergency department, urgent care center or retail clinic presumably would receive fewer tests, prescriptions and other services. Extended hours also may be a marker of an efficient practice.