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 |
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 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 doctor1–15 | |
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.