Variations in primary care physician referral rates.

Peter John Franks · Jack Zwanziger · Cathleen Mooney · Melony E. S. Sorbero

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Healthcare Systems and Technology Healthcare Policy and Management Primary Care and Health Outcomes

Abstract

OBJECTIVE: To examine primary care physician referral rate variations, including their extent and their stability over time and across diagnostic categories. DATA SOURCES: 1995/1996 claims data for adult patients from a large Independent Practitioner Association (IPA) model managed care organization (MCO) in the Rochester, NY metropolitan area. The IPA includes over 95 percent of area primary care physicians (PCPs), and the MCO includes over 50 percent area residents. STUDY DESIGN: Referral rates (patients referred to and seen by specialists one or more times/patients seen by PCP/year) were developed for the PCPs (457 general practitioners, family physicians, and internists) in the MCO, including observed referral rates, expected referral rates based on case-mix adjustment across the whole sample, physician-specific case mix-adjusted referral rates (empirical Bayes estimates), and diagnostic category-specific case mix-adjusted referral rates. PRINCIPAL FINDINGS: Wide variations in observed referral rates (0.01-0.69 patients referred/patients seen/year) were attenuated relatively little by case-mix adjustment and persisted in case mix-adjusted empirical Bayes estimates (0.02-0.65). The year-to-year case mix-adjusted referral rate correlation was .90. Correlations of case mix adjusted-referral rates across diagnostic categories were moderate (r=.46-.67). CONCLUSIONS: PCP referral rates exhibit wide variations that are independent of case mix, remain stable over time, and are generalizable across diagnostic categories. Understanding this physician practice variation and its relationship to costs and outcomes is critical to evaluating the effect of current efforts to reduce PCP referral rates.

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References

1992Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study 1997Referrals of adult patients from primary care: demographic disparities and their relationship to HMO insurance.1995Access to specialty care.1989How much variation in referral rates among general practitioners is due to chance?1992Variability in consultation rates and practitioner level of diagnostic certainty.

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2001Personal, Organizational, and Market Level Influences on Physicians’ Practice Patterns: Results of a National Survey of Primary Care Physicians 2019Differences in referral patterns for rural primary care physicians from 2005 to 2016

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