Appendix Exhibit 3.
Adjusted differences in patient experiences, use of preventive services, use of acute care, and total Medicare spending between patients served by high-priced versus low-priced practices
| Outcome | Adjusted Difference High-Low Priced Practices† | 95% Confidence Interval | P-value |
|---|---|---|---|
| Experiences with Care | |||
|
| |||
| Overall Ratings of Care and Physicians | |||
| Rating of health care | 0.001 | (−0.046, 0.048) | 0.962 |
| Rating of primary physician | 0.009 | (−0.032, 0.050) | 0.678 |
| Rating of specialist | −0.011 | (−0.064, 0.043) | 0.696 |
| Timely Access to Care | |||
| Timely access to care (3-item composite) | 0.009 | (−0.050, 0.068) | 0.753 |
| Waiting time in the office | 0.153 | (0.063, 0.243) | 0.001 |
| Interactions with Primary Physician | |||
| Physician interaction (4-item composite) | 0.025 | (−0.021, 0.071) | 0.288 |
| Care Coordination and Management | |||
| Primary physician informed about specialty care | 0.147 | (0.041, 0.252) | 0.007 |
| Patient care information available to primary physician | 0.011 | (−0.026, 0.048) | 0.550 |
| Medication review | 0.133 | (0.052, 0.215) | 0.001 |
| Patients’ access to visit notes | 0.056 | (0.043, 0.069) | <.0001 |
| Care management from physician’s practice | 0.112 | (−0.077, 0.301) | 0.246 |
| Communication of test results (2-item composite) | 0.087 | (0.011, 0.164) | 0.026 |
|
| |||
| Use of Preventive Services, % within timeframe | |||
|
| |||
| Influenza vaccine in last 1 year | 1.49 | (0.39, 2.59) | 0.008 |
| Pneumococcal vaccine (ever) ‡ | 1.75 | (0.56, 2.94) | 0.004 |
| Preventive services for diabetics ˆ | |||
| Glycated hemoglobin testing in last 1 year | 1.43 | (−0.77, 3.63) | 0.202 |
| Low-density lipoprotein testing in last 1 year | 0.14 | (−1.80, 2.08) | 0.888 |
| Diabetic retinal examination in last 2 years | 0.26 | (−1.80, 2.36) | 0.812 |
| Breast Cancer Screening in last 2 years § | −0.06 | (−3.93, 3.82) | 0.976 |
|
| |||
| Acute Care Use, No. Per Year | |||
|
| |||
| Emergency department visits not related to inpatient admissions | 0.008 | (−0.019, 0.035) | 0.566 |
| Acute hospitalizations | 0.009 | (−0.004, 0.023) | 0.176 |
| Hospitalizations for Ambulatory Care Sensitive Conditions | 0.002 | (−0.003, 0.008) | 0.377 |
|
| |||
| Total Annual Spending, $ | |||
|
| |||
| Annual Spending ¶ | 112.18 | (−240.41, 464.77) | 0.533 |
Notes: This table shows the estimated association between visiting a provider practice with a high vs. a below-average price and patient experiences with care, the receipt of preventive services, acute care visits, and health care spending.
Estimates are adjusted for geography at the level of Primary Care Service Areas (PCSAs) and for all patient-level characteristics in Exhibit 1 of the main manuscript except for self-rated general health, self-rated mental health, and functional limitations. All estimates are also adjusted for CAHPS survey weights.
Among patients ≥ 65 years old.
Among patients with a diagnosis of diabetes by the beginning of 2011 based on the Medicare Chronic Conditions Data Warehouse.
Among women 65–69 years old.
Includes all fee-for-service Medicare spending except for rehabilitation facility and long-term acute care facility spending.