Table 2.

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

Category and SettingAuthor, Year, Pub Code,* Reference #UtilizationCostClinicalRemarks
Concierge Medicine and Direct Primary Care
    MDVIPKlemes 2012 S41Hospital 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 S42MDVIP lower ED visits years 2 and 3; lower urgent care use all 3 years; lower inpatient readmits year 1; no differences hospital admissionsMean 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
    QlianceQliance 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
    IoraGovindarajan 2018 S4840% reduction in hospitalizations¬Patient retention 98%, 90% patients BP under control versus 60% in the industryNo control group
Shemkus 2015 N491 site: 37% fewer hospitalizations;
2 sites: 30% fewer ER visits
1 site: 12% decrease in costs¬No detail on controls
Schiff 2016 P5035% fewer hospitalizations, 23% fewer ER visits¬Patients w/high BP controlled = 64% in 2013 to 86% in 2016No detail on controls
    R-HealthBeck 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 visitsHigh prevalence of cholesterol and cancer screenings, drug adherence, blood sugar controlNo controls; #s reported are for R-Health and other DPCs serving private-sector employers
Multifaceted Care Models in Elders
    ChenMedTanio 2013 S521058 hospital days/1000 versus 1712 national¬Patients w/diabetes: 44% Rx possession increased to 73%Controls national mean
Ghany 2018 S53Lower 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 JC54ER 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
    WellMedPhillips 2011 S55No 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 rateMinimal outcome data reported; no control group
    SignatureSignature 2015 R56Intervention 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
    NAMCSChen2009 S58Visits 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 CareHulka 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/dysuriaUnclear if busy doctors doing less or recording less
Small patient n per doctor115
    Group Health Cooperative, Puget SoundHartzema 1983 S60Prescription 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 CentersCamasso 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 womenExclusion 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.