Services from hospital-based primary care providers were more likely to result in orders for imaging exams and specialty referrals than services from community-based primary care providers, according to research published Monday by JAMA Internal Medicine.
Researchers investigated data for more than 31,000 appointments occurring between 1997 and 2013 for patients with respiratory tract infection, back pain and headache to reach their conclusions.
The results indicate that hospital-based primary care physicians have a higher tendency to prescribe certain tests and services even when those tests and services deliver little value, according to Bruce Landon, a professor at Harvard Medical School and senior author of the study.
Hospital-based services have been criticized for years for delivering low-value to patients. Many health policy changes that have occurred over the past decade or so have been designed to encourage higher utilization of outpatient services.
The number of hospital beds has dipped since 1994 from 901,056 to 786,874 in 2014, according to the American Hospital Association Trendwatch Chartbook 2016. Meanwhile, outpatient services increased from slightly less than 13.2 million in 1994 to 17.4 million in 2014. The number of outpatient surgery centers has also increased from 4,039 in 2009 to 5,446 in 2014.
Policy changes that discourage inpatient care have coincided with a rise in demand for more consumer-friendly care settings. The trend toward consumer-friendly, outpatient-based healthcare services has driven traditional healthcare companies like Sutter Health and startups like One Medical to jump into the retail clinic game.
While figures from the JAMA Internal Medicine study suggest hospitals deliver lower value care than outpatient settings, it is possible that the data is outdated. Policy changes in recent years have generally been geared at reducing reliance on hospital-based care. On the other hand, hospitals have also been acquiring physician practices at a quicker pace in recent years.
Data from the JAMA Internal Medicine study also predates the most rigorous value-based care initiatives. Recent policy changes may end up revealing that hospital-based care is delivering higher value than it had before 2013.