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Home / News & IndustryManaged Care Insight and Analysis
Updated: Oct. 7, 2008
Visits To Primary Care Physicians May Decrease Hospital Stays At End-of-Life

Medicare beneficiaries can reduce their hospital use at the end-of-life with visits to primary care physicians, according to a study from Boston University School of Medicine (BUSM).

Researchers found that patients with more primary care visits in the year before their death resulted in less hospital utilization than those with fewer visits.

Those who had no primary care visits, 38 percent of Medicare beneficiaries in the study, had 15.3 days in the hospital while patients with at least nine visits had only 13.4 days, according to researchers.

Costs were also lower between patients with no visits versus those with nine or more. Care for those with no visits averaged approximately $24,400 while more visits cost $23,400, a difference of $1,000 per patient, according to the study.

The study also found that while 44 percent of those without primary care visits near the end of life died in the hospital, only 40 percent of patients with more visits did the same.

"Primary care visits in the preceding year of life are associated with less, and less costly, end-of-life hospital utilization," said Dr. Andrea Kronman, senior author and instructor of medicine at BUSM.

"Decreasing just one hospital day for each Medicare beneficiary at the end of life could have savedmillions of dollars," said Kronman.

Researchers evaluated 78,356 Medicare beneficiaries over the age of 66 for the study.

Current end-of-life treatments cost Medicare approximately 30 percent of its total spending.

Problems have arisen including late referrals to hospice, overtreatment, inefficient pain management and in-hospital deaths in the present system, according to researchers.

"More care at the end of life by a primary care physician could enhance quality and reduce costs," said Kronman, "since the provider may have more opportunities to prevent medical complications, discuss patient preferences and coordinate home palliative care."

Address: Boston University School of Medicine, 715 Albany St., Boston, MA 02118; (617) 638-5300,

  This article was taken from:
The Executive Report on Physician Organizations

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