Primary Care Physician Continuity Is a Consistent Measure Associated with Lower Costs and Hospitalizations

Objective: Continuity of primary care reduces costs and hospitalizations over 1-year periods, but its long-term effects remain unclear, a key concern for value-based payment. We examined associations between physician-level continuity and health care expenditures/utilization across single- and multi-year measurement periods. Design: Retrospective cohort study using 2011 to 2017 Medicare Fee-for-Service (FFS) claims. We constructed physician-level continuity measures over 1- to 5-year lookback periods. Generalized linear models estimated associations with total Medicare Part A & B expenditures, and logit models assessed hospitalization and emergency department (ED) visits, adjusting for patient and physician characteristics. Setting & Participants: Nationally representative sample of 4,940 primary care practices, including 1.1 to 2.5 million Medicare FFS beneficiaries seen by 6,758-14,949 physicians. Results: Beneficiaries in the highest continuity quintile had 7.4%-10.4% lower total expenditures than those in the lowest quintile, with the greatest difference in the 1-year lookback. Hospitalization and ED visit odds were 5.5%-8.6% and 4.9%-6.3% lower, respectively, for high-continuity physicians. Effects attenuated slightly with longer lookbacks. Conclusion: Physician continuity is consistently associated with lower costs, hospitalizations, and ED visits across lookback periods. Given this stability and the complexity of multi-year claims measurement, a 1-year assessment may be sufficient for physician continuity evaluation and value-based payment programs.