Does Going to This Type of Doctor Increase Health Care Costs?

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Scheduling an appointment with a primary care doctor who belongs to a large health system might cause an increase in health care spending, according to a recent study.

Such physicians tend to make more referrals to specialists, and emergency room visits and hospitalizations sometimes increase, according to the research out of Harvard T.H. Chan School of Public Health.

In short, physicians who work for health care systems like hospitals are more likely to recommend that patients use other services within those systems, compared with independent physicians.

For the study — which was published in JAMA Health Forum, a publication of the American Medical Association — researchers analyzed the experiences of more than 4 million patients in Massachusetts.

They found that among patients of physicians who were newly aligned with a health system, there was a 22.6% increase in specialist visits per patient per year. ER visits and hospitalizations within specific health systems also increased, although the total number of ER visits and hospitalizations did not increase significantly.

In addition, total medical expenditures jumped 6.3% — by $357 per patient per year — after a primary care physician entered into a vertical relationship, essentially meaning they started working directly for a health system like a hospital rather than in an independent medical practice.

In the study itself, the Harvard researchers write:

“These findings raised concern that the steering of care corresponded with insurers paying more for the same types of care visits and that this form of consolidation may be associated with overall higher costs. Moreover, we found that vertical relationships were associated with increased specialist visits within large health systems, which warrants further study to ascertain whether these visits represent low-value care or improved access to specialists.”

Some politicians — including the Biden administration — have turned their attention to vertical integration and consolidation of health care providers, according to a report in Fierce Healthcare.

The publication notes that federal agencies have proposed updates to guidelines for antitrust enforcement that address vertical integration. The updated guidelines could be used when the government decides whether to block a merger, Fierce Healthcare reports.

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