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Physician referral rates: style without much substance?
P Franks1, C Mooney, M Sorbero
1Primary Care Institute, Department of Family Medicine, University of Rochester, New York, USA. peter_franks@urmc.rochester.edu
Medical Care
|August 10, 2000
Summary
Primary care physicians' (PCPs) varying referral rates show no significant link to patient costs or health outcomes. Efforts to limit PCP referrals may not be effective for improving care quality or reducing healthcare spending.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Economics
Background:
- Primary care physicians (PCPs) demonstrate significant variability in specialist referral rates.
- The impact of these differing referral patterns on healthcare costs and patient outcomes remains largely unexplored.
Purpose of the Study:
- To investigate the association between PCP referral rates and healthcare expenditures.
- To examine the relationship between PCP referral rates and the risk of avoidable hospitalizations.
- To assess the connection between PCP referral rates and patient-reported health status and satisfaction.
Main Methods:
- Cross-sectional analysis utilizing claims data and patient survey responses.
- Involved 457 PCPs and 217,606 adult patients within a managed care organization.
- Measured total expenditures, avoidable hospitalization risk, SF-12 health scores, and satisfaction.
Main Results:
- No statistically significant relationship was found between case-mix adjusted PCP referral rates and per-panel member costs.
- The case-mix-adjusted referral rate did not correlate with the risk of avoidable hospitalizations.
- No adjusted association was observed between PCP referral rates and patients' self-rated physical or mental health, though a modest direct relationship existed with patient satisfaction.
Conclusions:
- Wide variations in PCP referral rates do not appear to significantly impact patient costs or health outcomes.
- Current strategies aimed at restricting PCP referrals may be misdirected.
- Further research is needed to understand the nuances of physician referral behavior and its true effect on patient care.