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Extending Access to Primary Care Cuts Costs 10%

Chelsea Rice, for HealthLeaders Media, October 15, 2012

"When you say there is a 10% saving in healthcare expenditures, certainly practices didn't save any money. The payers saved money, because they are the ones paying the bills," says Czapp.

For example, if a patient has the option to visit their primary care physician for bronchitis at night or on a weekend instead of making a trip to the ED,  there is a potential cost savings.

The jury is still out as to whether the upfront costs of extending office hours would necessarily lead to savings down the road. And physicians expect to be compensated for those costs.

There are some pilot programs where payers are adopting a shared-savings approach and paying practices upfront to get them to expand their hours in an effort  to reduce downstream spending. But it's still experimental.

"[Ten percent is] huge in our healthcare system. I would've expected 1 or 2 percent. Now the payers have a compelling case to recognize extended hours coverage in their payment models," says Robert Berenson, MD, a fellow at the Urban Institute who researches healthcare cost expenditures and physician payment structures.

What about the work-life balance issues for physicians and staff?  

"It doesn't necessarily have to require added hours, it can be substituted hours," says Berenson. "I think most practices would find it financially a desirable thing to have extra hours coverage if it's consistent with people's lifestyles."

"Obviously if you just have a few staff and they have childcare responsibilities and have to be home, well then it's hard to work from 12 to 8 in the evening, but again I think that many practices would actually find that some of the staff members would prefer to have time off during the day and to work the evenings."  

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