Assistant Professor of Health Policy and Management Kimberley Geissler at the University of Massachusetts Amherst School of Public Health and Health Sciences examines the role organizational affiliations play in physician referrals in a study appearing in a recent issue of Medical Care Research and Review.
Healthcare policy advocates have identified care coordination between primary care physicians (PCPs) and specialists as a key strategy for improving the healthcare system. Provider consolidation, such as hospital acquisitions of physician groups, may enable improved care coordination, but raises concerns about lack of competition leading to ultimately higher prices. Physician referrals play a key role in constructing patient care teams, but it is unknown how organization affiliations affect these.
In the study, Dr. Geissler, with colleagues from Boston University, studied the role that organizational affiliations play in referral relationships between primary care physicians (PCPs) and specialists. Using the Massachusetts All Payer Claims Database, the researchers examined whether referral relationships were associated with sharing a practice site, medical group, and/or a physician contracting network.
Dr. Geissler and team found that PCP-medical specialist pairs in the same practice site were substantially more likely to have a referral relationship than those who were not, and somewhat more likely to have relationships within medical groups. To their surprise, however, they found no significant association between referral relationships and physician contracting networks.
Their findings may help illuminate referral incentives and provide insight into the role organizational affiliations play in patient care team construction.
“Our results give a sense of the degree of formal and informal incentives for physicians to refer within physician contracting networks and medical groups,” the authors write. “Our research is an important step in documenting the associations between organizational structure and patient-sharing patterns. Further research is needed to determine additional factors influencing these patient-sharing relationships, including whether consolidation of increasingly large provider organizations impact referral patterns.”