Emergency Department and Inpatient Hospital Use by Medicare Beneficiaries in Patient-Centered Medical Homes

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Martijn Van Hasselt, Assistant Professor (Creator)
Institution
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/

Abstract: Study objectivePatient-centered medical homes are primary care practices that focus on coordinating acute and preventive care. Such practices can obtain patient-centered medical home recognition from the National Committee for Quality Assurance. We compare growth rates for emergency department (ED) use and costs of ED visits and hospitalizations (all-cause and ambulatory-care-sensitive conditions) between patient-centered medical homes recognized in 2009 or 2010 and practices without recognition.MethodsWe studied a sample of US primary care practices and federally qualified health centers: 308 with and 1,906 without patient-centered medical home recognition, using fiscal year 2008 to 2010 Medicare fee-for-service data. We assessed average annual practice-level payments per beneficiary for ED visits and hospitalizations and rates of ED visits and hospitalizations (overall and ambulatory-care-sensitive condition) per 100 beneficiaries before and after patient-centered medical home recognition, using a difference-in-differences regression model comparing patient-centered medical homes and propensity-matched non–patient-centered medical homes.ResultsComparing patient-centered medical home with non–patient-centered medical home practices, the rate of growth in ED payments per beneficiary was $54 less for 2009 patient-centered medical homes and $48 less for 2010 patient-centered medical homes relative to non–patient-centered medical home practices. The rate of growth in all-cause and ambulatory-care-sensitive condition ED visits per 100 beneficiaries was 13 and 8 visits fewer for 2009 patient-centered medical homes and 12 and 7 visits fewer for 2010 patient-centered medical homes, respectively. There was no hospitalization effect.ConclusionFrom 2008 to 2010, outpatient ED visits increased more slowly for Medicare patients being treated by patient-centered medical home practices than comparison non–patient-centered medical homes. The reduction was in visits for both ambulatory-care-sensitive and non–ambulatory-care-sensitive conditions, suggesting that steps taken by practices to attain patient-centered medical home recognition such as improving care access may decrease some of the demand for outpatient ED care.

Additional Information

Publication
Annals of Emergency Medicine, 65(6)
Language: English
Date: 2015
Keywords
patient-centered medical homes, emergency care

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