Study Reveals Complexity of Primary Care Visits

Individuals with more than 1 diagnosis are more likely to report to a primary care physician than to a subspecialty physician, according to researchers from the Robert Graham Center in a study published in Primary Care Diabetes.

Miranda Moore, PhD, economist for the Robert Graham Center, and colleagues wanted to expand the research on office-based visits to primary care; using diabetes as a case study, the researchers measured the number of health conditions addressed by primary care physicians and compared them to the number addressed by subspecialty physicians in order to see if and how the visits varied by physician specialty type.

The team utilized Medical Expenditure Panel Survey data, focusing on adults diagnosed with diabetes and then categorized the sample based on number of visit diagnoses, number of conditions reported, and type of physician seen.

“When patients think about their overall health, they think about their primary care physician,” Dr Moore said in a statement. “When they think about individual conditions, they think about their subspecialist.”

They found that 80% of visits to subspecialist physicians involved care for a single diagnosis while 55% of visits to primary care physicians involved care for at least one additional diagnosis. The researchers also identified that 70% of visits with one diagnosis were reported to subspecialist physicians while 90% of visits with 4 diagnoses were reported to primary care physicians. Adults with diabetes report more conditions being cared for per visit with primary care physicians than with subspecialty physicians.

The researchers hope to see more studies focusing on their findings in order to determine whether their results hold true across other chronic conditions. They point out that as the US healthcare system moves from volume to value, encounter complexity will need to be recognized and more accurately compensated.

“As we move forward with changing the way we pay for care, we need to look at the breadth of what’s being addressed within each office visit to measure complexity,” Dr Moore said. “We need to consider various measures of the complexity of care physicians provide in a single visit.”