|Scope Of Care Coordination Daunting For Physicians Treating Medicare Patients
Illustrating the formidable task of coordinating care, a
typical primary care physician who treats elderly Medicare patients
must coordinate care with 229 other physicians working in 117 different
practices, according to a study by researchers at the Center for
Studying Health System Change (HSC), Memorial Sloan-Kettering Cancer
Center (MSKCC) and the Dana-Farber Cancer Institute.
The study was published in the Annals of Internal Medicine.
"The logistical challenges to care coordination are
daunting given the fragmentation of care and the large number of peers
that physicians must interact with when treating Medicare patients,"
said Dr. Hoangmai H. Pham, the study’s lead author and an HSC
senior health researcher.
Policy-makers and insurers are searching for strategies
to improve care coordination and reinvigorate primary care as a
critical component of reforming the U.S. healthcare system. As Medicare
and private health plans experiment with extra payments to primary care
physicians to coordinate care — for example, through medical
homes — the study findings suggest that substantial delivery
system reforms may be needed to make such models work.
"Without changes that foster increased integration of
physicians — either in virtual or actual organizations —
care coordination is likely to remain an ideal but elusive goal in
Medicare,’ Pham said.
The study, "Primary Care Physicians’ Links to
Other Physicians Through Medicare Patients: The Scope of Care
Coordination," is based on HSC’s nationally representative
2004-05 Community Tracking Study Physician Survey, which collected
information from 6,600 practicing physicians, and Medicare claims
information on beneficiaries these physicians treated in 2005.
Data on physicians and patients were linked with the use
of the physicians’ unique provider identification number, and a
total of 2,284 primary care physicians and 576,875 elderly Medicare
patients were included in the study.
Each primary care physician in the study treated an
average of 264 unique Medicare fee-for-service patients. For every 100
Medicare patients treated, each primary care physician would typically
have to communicate with 99 physicians in 53 practices to coordinate
care, the study found.
Physicians who treated patients with more chronic
conditions (patients in the highest quartile of chronic illness burden)
typically had to interact with 134 physicians in 62 practices for every
100 Medicare patients.
The study also found that physicians working in solo or
two-person practices had more peers (median, 69 practices per 100
Medicare patients) than physicians in larger group practices and
institutional worksettings. The median number of practices among peers
per 100 Medicare patients was higher in urban areas (median, 60
practices) than in rural areas (median, 36 practices).
The number of physician peers also varied across census
regions, ranging from a median of 37 practices per 100 Medicare
patients in the East South Central Region (Alabama, Kentucky
Mississippi and Tennessee) to 81 practices in the Mid-Atlantic region
(New Jersey, New York and Pennsylvania).
Addresses: Center for Studying Health System Change, 600 Maryland Ave. SW, Suite 550, Washington DC 20024; (202) 404-5261, www.hschange.com. Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065; (212) 639-2000, www.mskcc.org. Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115; (617) 6321-3000, www.dana-faber.org.