Evaluation of common problems in primary care: Effects of physician, practice, and financial characteristics

Objectives: To identify the resource use and costs associated with the diagnosis of common problems in primary care practice and to investigate the influence of physician characteristics, practice organization, and financial incentives on physician behavior. Study Design: Cross-sectional survey. Patients and methods: A national sample of 1721 primary care physicians from 53 managed care organizations were surveyed about their use of diagnostic laboratory, imaging, and invasive procedures; ambulatory visits; empiric drug therapies; and specialty consultations for a hypothetical middle-aged female patient presenting with 1 of 6 common clinical problems: depression, fatigue, impaired memory, anxiety, low back pain, or high cholesterol. Information regarding the physician's arrangement with managed care organizations was also collected. Cost estimates were made from Maryland Medicare Fee Schedule and Red Book data. Results: Total costs (mean ± standard deviation) were estimated for management of depression ($520 ± $235), fatigue ($389 ± $201), impaired memory ($569 ± $243), high cholesterol ($367 ± $191), low back pain ($726 ± $369), and anxiety ($438 ± $207). Younger physicians (less than 50 years old) generated higher costs in the treatment of depression but used fewer resources in the evaluation of high cholesterol. Physicians paid by salary had significantly lower costs compared with physicians in fee-for-service arrangements for depression and high cholesterol (P < .05). Physicians in multi-specialty groups were more likely to have lower costs for depression and low back pain in multivariate analyses. More stringent financial incentives such as capitation, withholds, and bonuses were not associated with lower costs. Conclusions: Multispecialty group practice and compensation by salary consistently predict lower costs for evaluation of common problems in primary care practice. Financial incentives such as capitation, withholds, and bonuses were not associated with an effect on costs of diagnostic evaluation.