Primary Care Physician Continuity Is a Consistent Measure Associated with Lower Costs and Hospitalizations.

Abstract

Continuity of primary care reduces costs and hospitalizations over 1-year periods, but its long-term effects remain unclear, a key concern for value-based payment. We examined associations between physician-level continuity and health care expenditures/utilization across single- and multi-year measurement periods. Retrospective cohort study using 2011 to 2017 Medicare Fee-for-Service (FFS) claims. We constructed physician-level continuity measures over 1- to 5-year lookback periods. Generalized linear models estimated associations with total Medicare Part A & B expenditures, and logit models assessed hospitalization and emergency department (ED) visits, adjusting for patient and physician characteristics. Nationally representative sample of 4,940 primary care practices, including 1.1 to 2.5 million Medicare FFS beneficiaries seen by 6,758-14,949 physicians. Beneficiaries in the highest continuity quintile had 7.4%-10.4% lower total expenditures than those in the lowest quintile, with the greatest difference in the 1-year lookback. Hospitalization and ED visit odds were 5.5%-8.6% and 4.9%-6.3% lower, respectively, for high-continuity physicians. Effects attenuated slightly with longer lookbacks. Physician continuity is consistently associated with lower costs, hospitalizations, and ED visits across lookback periods. Given this stability and the complexity of multi-year claims measurement, a 1-year assessment may be sufficient for physician continuity evaluation and value-based payment programs.