The loss of a primary care physician (PCP) is associated with lower use of primary care and increased use of specialty, urgent, and emergency care (JAMA Intern Med. 2020;e206288. doi:10.1001/jamainternmed.2020.6288).
“Disruptions of continuity of care may harm patient outcomes, but existing studies of continuity disruption are limited by an inability to separate the association of continuity disruption from that of other physician-related factors,” wrote Adrienne Sabety, PhD, Department of Economics, University of Notre Dame (Notre Dame, IN) and colleagues.
This cohort study examined the changes in health care use and outcomes among patients whose PCP exited the workforce. National Medicare billing claims of Medicare fee-for-service beneficiaries with at least 1 PCP evaluation and management visit were used in the analysis. PCPs who stopped practicing were matched with PCPs remaining in the practice. A difference-in-difference analysis compared health care use and clinical outcomes.
During the study period of January 1, 2008 to December 31, 2017, 10.4% of PCPs exited Medicare. The year after exit, the PCPs former patients had 18.4% fewer primary care visits and 6.2% more specialty care visits, 17.8% more urgent care visits, 3.1% more emergency department visits, and greater spending per beneficiary compared with beneficiaries who did not lose a PCP. This trend continued for 2 years after PCP exit. These increases were more prominent in patients of PCPs exiting solo practice.
“Loss of a PCP was associated with lower use of primary care and increased use of specialty, urgent, and emergency care among Medicare beneficiaries,” concluded Dr Sabety and colleagues. “Interrupting primary care relationships may negatively impact health outcomes and future engagement with primary care.”—Lisa Kuhns
