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When doc's office is open longer, patient costs dip

Medical ResearchMedicine

NEW YORK (Reuters Health) - People whose doctors keep longer office hours may spend a little less on healthcare, a new study finds.

Using survey data from more than 30,700 Americans, researchers found that 36 percent said their doctor offered weekend and evening hours.

And over two years, those patients spent 10 percent less on medical care than people whose doctors stuck with traditional weekday hours - a difference of more than $1,000.

The reasons are not yet known, and it's possible that the longer hours "caused" the lower spending, according to lead researcher Dr. Anthony Jerant, of the University of California Davis School of Medicine in Sacramento.

But that seems unlikely based on the results, Jerant said. One way longer office hours would cut spending would be to give patients an alternative to the emergency room. But fewer ER visits did not account for the lower spending here.

"It may be that extended hours is a marker for more cost-conscious practice overall -- and this is what we think is the most likely explanation," Jerant said in an email.

In support of that, his team found that lower spending on prescriptions and office visits seemed to largely account for their results.

"So this suggests that cost-effective prescribing and care in general - less ordering of expensive office tests and expensive brand-name drugs - helped to 'explain' the relationship between extended hours and expenditures," Jerant said.

Why would doctors with longer office hours be more thrifty?

Jerant speculated that extended hours may be just one measure that some doctors are taking to offer more "patient-centered" care that is also cost-effective.

But this study cannot prove that is the case, Jerant pointed out. It was an observational study that looked at the relationship between office hours and spending -- not the underlying reasons.

MIGHT NOT BE EASY

The findings, reported in the Annals of Family Medicine, are based on data from an annual government survey that asks U.S. adults about their healthcare use.

Jerant's team focused on 30,714 participants who had a regular source of care over two years. They found that people with access to extended office hours spent about $3,800 to $4,000 each year on all medical care.

That compared with almost $5,200 to $5,500 among people whose doctors did not have extended office hours.

The researchers accounted for other factors, like people' age, race, number of chronic health conditions and insurance coverage. And extended office hours remained linked to a 10 percent dip in healthcare spending.

"I think it is premature to use our study findings to suggest that extended hours themselves, if added by more primary care offices, would cut spending," Jerant said.

If longer hours are really just a "marker" of a practice's overall cost-cutting ways, then simply adding hours would be unlikely to make a dent in healthcare spending.

Jerant said more studies are needed to get at the reasons for the current findings.

If future research does show that longer office hours directly curb spending, it may be feasible for most primary care offices to keep the doors open longer, according to Jerant.

But with the added resources needed, it might not be "easy," he added.

SOURCE: http://bit.ly/Oqwalz Annals of Family Medicine, September/October 2012.

Copyright © 2014, The Baltimore Sun
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