The assumption that Medicare costs are being contained because one physician mainly manages a patient's care has been shattered by a study released Thursday in the New England Journal of Medicine. The findings raise concerns over the potential effectiveness of a pay for performance (P4P) program, researchers said.
The study found that the majority of Medicare patients see two primary care physicians and five specialists working in four different practices, according to researchers from the Memorial Sloan-Kettering Cancer Center and the Center for Studying Health System Change (HSC).
"Improving the care of patients with multiple chronic illnesses is where P4P has its greatest potential -- but ironically, implementation will be more challenging, because these patients see even more doctors," said Peter Bach, MD, Memorial Sloan-Kettering Cancer Center researcher and study coauthor.
Hoangmai H. Pham, MD, senior researcher for HSC and lead author said, "The study raises serious questions about how meaningful a Medicare pay-for-performance program would be for patients in the current fee-for-service system where care is so widely dispersed."
The study was taken from the Community Tracking Study Physician Survey of 8,604 physicians and based on 1.79 million fee-for-service Medicare beneficiary claims from 2000 to 2002.
Researchers "assigned" primary care physicians to beneficiaries where possible for the study, based on the most number of visits patients made to a particular doctor. Additional findings included:
• a median of 35 percent of beneficiaries' visits each year were with their assigned physicians
• for 33 percent of beneficiaries, the assigned physician changed from one year to another
• on the basis of all visits to any physician, a primary care physician's assigned patients accounted for a median of 39 percent of the physician's Medicare patients and 62 percent of Medicare visits
• for medical specialists, assigned patients accounted for a median of 6 percent of the specialists' patients and 10 percent of Medicare visits
• on the basis of visits to primary care physicians only, 79 percent of beneficiaries could be assigned by researchers to a physician
• a median of 31 percent of beneficiaries' visits were with their assigned primary care physician.