A new study published in the Journal of the American Medical Association examines how practice ownership and location impacts the level of care primary care practices provide.
The study authors examined data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to learn more about hospital-owned and hospital-based practices and compare their data to physician-owned and community-based practices.
The data for patients with common conditions, including upper respiratory tract infection, back pain and headaches, was gathered. There were 31,162 visits for patients with upper respiratory tract infections, back pain and headaches, which represented around 739 million primary care visits from 1997 to 2013. The researchers found:
1. The patients visiting hospital-based physicians were younger overall than those visiting community based physicians, aged 44.5 years old compared to 49.1 years old.
2. Nearly 53 percent of the patients visiting the hospital-based practices saw their primary care providers frequently, compared with 82 percent of those visiting community-based practices.
3. Both physician groups reported similar antibiotic use. The hospital-based physicians were more likely to order CT and MRI. More than 12 percent of the hospital-based physicians ordered radiographs, compared with 10 percent of community-based physicians.
4. Nineteen percent of the hospital-based visits ended in specialty referrals, compared to 7.9 percent of community-based visits.
5. The patients visiting generalists instead of a primary care provider were associated with low-value care, primarily in the hospital setting.
"These findings raise concerns about the provision of low-value care at hospital-associated primary care practices," concluded the study authors.