Table 4.

Effect of Level 1, Level 2, or Level 3 Equivalent PCMH Recognition on Utilization, Continuity of Care, Process Measures, and Medicare Expenditures

	Estimate
	No Equivalent Recognition Sites (N = 97)	Level 1, 2, or 3 Equivalent Recognition Sites (N = 707)	Difference (Level 1, 2, or 3 Equivalent Recognition – No Equivalent Recognition)	95% Confidence Interval
Utilization, per 1000 beneficiaries per year
FQHC visits	4705	4933	228	176, 278
Non-FQHC primary care visits	417	414	−3	−19, 11
Specialist visits	2993	3173	181	124, 232
ED visits	942	1007	64	35, 89
Inpatient admissions	346	340	−6	−22, 6
Inpatient ACSC admissions	44	47	3	−2, 7
Inpatient readmissions, percentage points	14.2	14.8	0.6	−0.5, 1.6
Continuity of Care, points
Provider-level continuity	0.69	0.66	−0.03	−0.04, −0.02
Practice-level continuity	0.83	0.85	0.02	0.01, 0.03
Process, percentage points
All four recommended diabetes tests	20.6	25.2	4.6	2.5, 6.7
HbA1c test	84.3	86.4	2.1	−1.1, 5.3
LDL test	78.1	80.8	2.8	0.4, 5.1
Eye exam	43.5	44.3	0.8	−1.9, 3.6
Nephropathy test	50.5	58.2	7.7	4.1, 11.3
Lipid test for patients with ischemic vascular disease	76.1	77.4	1.3	−1.1, 3.8
Medicare expenditures, dollars per beneficiary per year
Total Medicare expenditures	9458	9811	353	65, 614
Inpatient expenditures	3256	3214	−42	−198, 96
Part B expenditures	1813	1924	111	61, 158

HbA1c = glycated hemoglobin, LDL = low-density lipoprotein cholesterol

Note: Bold entries denote differences that are statistically different from zero based on a P value <0.05. All models incorporate propensity score weights and are adjusted for beneficiary characteristics (age, race, gender, dual eligibility, disability, institutionalization, Hierarchical Condition Category score); site characteristics (revenue, years in operation, number of primary care providers, number of specialists, number of other affiliated sites, ambulatory care accreditation, participation in a Health Center Controlled Network, % uninsured patients, % Medicaid patients, FQHC Affordable Care Act grant recipient); and area characteristics (rural–urban continuum code, % household poverty in the site’s census tract). A total of 8276 of 239,439 observations (3.5%) were dropped from the main analysis because the propensity scores for these beneficiaries fell outside of the common support (i.e., did not overlap with those in the alternative group).

FQHC visits include any visit to an FQHC regardless of provider specialty. Non-FQHC primary care visits include visits to primary care physicians, nurse practitioners, and physician assistants who practice in rural health clinics or office settings. Specialist visits include visits to physicians, nurse practitioners, or physician assistants who have specialties other than primary care and who practice in an FQHC, rural health clinic, or office setting. ED visits include both ED visits that did and did not lead to a hospitalization, as well as observation stays. Inpatient ACSC [ambulatory care-sensitive condition] admissions are those with a primary diagnosis of: one or more diabetes short-term complications; one or more diabetes long-term complications; chronic obstructive pulmonary disease or asthma in older adults; hypertension; congestive heart failure; angina without procedure; uncontrolled diabetes; asthma in younger adults; and lower-extremity amputation among patients with diabetes. Inpatient readmissions were measured as 30-day unplanned hospital-wide readmissions.

Total Medicare expenditures include inpatient, outpatient, skilled nursing facility, home health, hospice, durable medical equipment, and Part B expenditures. Inpatient expenditures include all claims found in the inpatient file. Part B expenditures include all claims for services found in the carrier file (also known as the Physician/Supplier Part B claims file).