Medicare Beneficiaries With a Specialist as Their Personal Doctor Report Better Experiences With Care. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Collins, Rebecca L.; Elliott, Marc N.; Burkhart, Q; Haviland, Amelia; Gaillot, Sarah; Orr, Nate; Friedberg, Mark W.
• Is Part Of: Medical care. Volume 57:Issue 6(2019)
• Publication Date: 2019-06
• Subjects: physician specialty -- patient centered care -- patient surveys -- primary care; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001122
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Health plans often require that patients have a personal doctor. Older adults rely on specialists for much of their care and may use a specialist in this role, but little is known about how many or which Medicare beneficiaries use specialists as their personal doctor and how their care experiences differ from others'. Objective: To examine the prevalence and characteristics of Medicare beneficiaries with a specialist as a personal doctor and compare their patient experiences and immunization to other beneficiaries'. Research Design: Logistic regression predicted having a specialist as a personal doctor from beneficiary characteristics. Doubly-robust models compared 7 patient experience and 2 immunization measures for beneficiaries with and without a specialist as their personal doctor. Interactions of a specialist indicator and beneficiary characteristics tested for moderators. Study Population: A total of 227, 642 Medicare beneficiaries aged 65+ who reported having a personal doctor on the 2014 Medicare CAHPS survey. Results: In total, 20% of beneficiaries reported that their personal doctor was a specialist, fewer than previously reported for the most frequently visited physician (43%); beneficiaries who were older, less healthy, less educated, racial/ethnic minorities, had fee-for-service coverage, or had lower income were more likely to do so. They also reported better patient experiences than those with nonspecialist personal physicians on 6 of 7 measures and more immunizations; the largest difference was for care coordination. Having a specialist personal doctor was associated with particularly positive patient experience for low income, Black, Hispanic, and less healthy beneficiaries. Conclusion: Future research should investigate whether specialists as personal doctors may reduce patient-experience disparities for vulnerable patients. Abstract : Supplemental Digital Content is available in the text.