Table 2.

Results of Reviewed Reports (1979–2019) on the Effects of Primary Care Consultation Duration

Category and Setting	Author, Year, Pub Code,^* Reference #	Utilization	Cost	Clinical^†	Remarks
Concierge Medicine and Direct Primary Care
MDVIP	Klemes 2012 S⁴¹	Hospital admission rates lower in MDVIP by these percentages (by year): Commercial: 49%, 58%, 61%, 65%, 72% Medicare: 71%, 71%, 74%, 75%, 79% Readmissions lower in MDVIP Medicare patients in 2009 by 97% acute MI, 95% CHF, 91% pneumonia	Estimated savings to the 5 states: $109.2 million Medicare, $10.2 million commercial	¬	Concierge care enrollment voluntary, thus concierge patients and concierge MDs may differ; deaths not measured
MDVIP	Musich 2016 S⁴²	MDVIP lower ED visits years 2 and 3; lower urgent care use all 3 years; lower inpatient readmits year 1; no differences hospital admissions	Mean monthly cost increase (vs controls) $86 year 1, $29 year 2, $2 year 3 Savings ≥ $150 pmpm (monthly fee) for 24%, 26%, 63% MDVIP in years 1 to 3 Patient traits associated w/savings magnitude: Year 1: chronic conditions, more prescriptions, older (55 to 64) Year 2: chronic conditions, 35 to 64 Year 3: no distinctions	¬	Self-selection may influence results despite matching
Qliance	Qliance 2015 P⁴⁷ Wu 2010 P⁴⁴	92% more primary care visits Fewer ED visits (by 65%), hospital visits (35%), hospital days (43%), specialist visits (66%), advanced radiology (63%), surgeries (82%)	¬	¬	No details enabling evaluation of results
Qliance	Qliance 2015 P⁴⁷ Huff 2015 JC⁴⁵	58% more primary care visits Fewer ED visits (by 14%), hospital days (60%), specialist visits (14%), advanced radiology (29%)	Savings per patient-year: net $679 (19.6% of fees). Includes decreases $5 ED, $417 hospital, $436 specialists, $82 advanced radiology; and increase $251 primary care	¬	Enrollment voluntary; no data. Available to determine comparability of enrollees to controls
Iora	Govindarajan 2018 S⁴⁸	40% reduction in hospitalizations	¬	Patient retention 98%, 90% patients BP under control versus 60% in the industry	No control group
	Shemkus 2015 N⁴⁹	1 site: 37% fewer hospitalizations; 2 sites: 30% fewer ER visits	1 site: 12% decrease in costs	¬	No detail on controls
	Schiff 2016 P⁵⁰	35% fewer hospitalizations, 23% fewer ER visits	¬	Patients w/high BP controlled = 64% in 2013 to 86% in 2016	No detail on controls
R-Health	Beck 2017 N³⁹ Brubaker 2019 N⁵¹	¬	15% savings to employers on total costs; 27% savings for 1 employer over 4 years via fewer ED and UC visits	High prevalence of cholesterol and cancer screenings, drug adherence, blood sugar control	No controls; #s reported are for R-Health and other DPCs serving private-sector employers
Multifaceted Care Models in Elders
ChenMed	Tanio 2013 S⁵²	1058 hospital days/1000 versus 1712 national	¬	Patients w/diabetes: 44% Rx possession increased to 73%	Controls national mean
	Ghany 2018 S⁵³	Lower hospital admissions (0.10 vs 0.20, P< .01); more annual primary care visits (8.7 vs 3.8, P< .01)	Care costs ($87 median pmpm, 95% CI: $26 to 278) ChenMed versus $121 (95% CI, $52 to $284) controls (P< .01)	More frequent use of 5 cardiovascular medications (all< 0.01)	Matching on only 3 factors
	Chen 2017 JC⁵⁴	ER visits 33.6% lower than other Medicare (500 vs 753 per 1000 patients) Hospital days 26% lower (1246 vs 1677 per 1000 patients)	ED $269,000 savings/1000 patients Hospital $979,000 savings/1000 patients	¬	Controls from general population, not matched
WellMed	Phillips 2011 S⁵⁵	No significant change in ER or hospital admissions/readmissions	¬	Rise in preventive screening for colon cancer and mammo and screening + optimal levels for HgA1c, LDL, and BP in high-risk groups. Mortality half state age-specific rate	Minimal outcome data reported; no control group
Signature	Signature 2015 R⁵⁶	Intervention 30% fewer ED visits than control; 43% fewer acute hospital admissions	¬	¬	Based on interview, no data published Decent control strategy
Observational Studies on Consultation Duration and Patient Outcomes
NAMCS	Chen2009 S⁵⁸	Visits with any of 3 counseling/screening indicators (dietary, exercise, BP check) 2.6 to 4.2 minutes longer than visits without (P< .001)	¬	Appropriate treatment not associated with visit length
North Carolina Ambulatory Care	Hulka 1979 S⁵⁹	¬		Doctors w/heavier workload lower adherence for hypertensives and women w/dysuria; less patient history detail for all but women w/dysuria; less physical exam detail for diabetics. Greater lab for patients w/general exams and women w/dysuria	Unclear if busy doctors doing less or recording less Small patient n per doctor^1–15
Group Health Cooperative, Puget Sound	Hartzema 1983 S⁶⁰	Prescription volume associated with larger panel size and older patients independent of # visits (46% of variance); patients/hour and visits/month (14%); clinic differences (8%)	¬	¬
Pennsylvania Primary Care Centers	Camasso 1994 S⁶¹	¬	Busier doctors more likely to make referrals.	Patients of busier doctors more likely to receive procedures from support staff, less likely to receive immunizations, full medical history, and preventive care for women	Exclusion of chronic conditions skews primary care population

P values are noted where available.
NCD, noncommunicable disease; SES, socioeconomic status.
BP, blood pressure; CHF, congestive heart failure; DPC, direct primary care; ED, emergency department; ER, emergency room; HgA1c, hemoglobin A1c; LDL, low-density lipoprotein; MI, myocardial infarction; NAMCS, National Ambulatory Care Medical Survey; pmpm, per member per month; UC, urgent care.
↵* Publication codes (for primary reporting): N = newspaper, S = scientific research article, JC = academic journal commentary, P = publicity, trade journal, R = report.
↵† Preventive care, examination-related performance, medication adherence and prescription volume, and mortality.
Electronic copies of tables available from authors.