More Primary Care at End of Life Lowers Costs

Debra Shute, January 26, 2017

Too many specialists overwhelm a primary care provider's ability to coordinate care and can lead to more intense, and costly treatment.

Claire K. Ankuda, MD
Claire K. Ankuda, MD

Regions of the country with greater primary care physician involvement in the last six months of life appear to have lower-intensity, lower-cost end-of-life care, according to research by published in the January/February 2017 issue of Annals of Family Medicine.

For purposes of the study, "primary care involvement" was defined as the ratio of PCP to specialist visits. The following interview with researcher Claire K. Ankuda, MD, MPH, with the Robert Wood Johnson Clinical Scholars Program at the University of Michigan Health System in Ann Arbor, and colleagues about the significance of these findings has been lightly edited.

HealthLeaders Media: Your study found that there was lower Medicare spending in the last two years of life in regions with more primary care physician involvement ($65,160 vs. $69,030). Can you put those numbers into context for healthcare leaders?

Claire Ankuda, MD: While the absolute dollar amount of around $4,000 over two years may not seem like a tremendous amount, even to some people within the healthcare industry, it's very significant if you think about the sheer number of Medicare beneficiaries we're talking about.

It's also important to understand that this is not a randomized controlled trial. We are really comparing regions of the country, so we did adjust for other factors that are different from place to place and which might also impact cost. With that in mind, our estimates are likely quite conservative.

HLM: In instances where there is more PCP involvement, where do the savings come from?

Ankuda: We know that a lot of what drives cost at the end of life are things like intensive care use and acute care hospital stays.

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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