New Research Says Discouraging Continuity Of Care Could Be A Mistake

These days, thanks to the intertwined factors of regulation and consolidation, long-lasting patient-physician relationships are fewer and farther between. But recently, a few researchers have set out to quantify the positive effects of care continuity. One of those researchers is right here in Dallas.

Southern Methodist University’s Vishal Ahuja, an assistant professor of operations management, looked at a massive swath of Veterans Affairs data related to Diabetes patients. He analyzed how care continuity—in other words, long-term relationships between patients and doctors—impacted hospitalizations, length of stay, and 30-day readmissions.

“In all three cases, what I found was: the better the care continuity, the better the patient outcomes,” says Ahuja, who is also an adjunct assistant professor of clinical sciences at UT Southwestern Medical Center.

He adds that continuity contributed to a more efficient use of hospital resources, and that continuity was an even bigger helper when it came to the most severe cases.

Those findings stand in contrast to the current market: Ahuja says that although consolidation of the healthcare industry here and elsewhere has some upside—greater profits, for instance—it hasn’t helped with regard to continuity of care.

That’s a point explored in a recent New York Times Magazine story under the headline, “Trying to put a value on the doctor-patient relationship.” The magazine devotes a feature-length piece to the shifting idea of the primary care physician, and to what the shift means for patients. Here’s the author, Kim Tingley, in the big-picture paragraph (the “nut graf,” as we call it in the biz) of the opening section:

The question of what the role of a primary-care physician should be, and how it should be valued, has perhaps never been more urgent. That figure, typically a general practitioner, family doctor or internist, is a patient’s first and often most personal connection to the rest of the health care system. But well-known corporations are betting that Americans would prefer to have health care “delivered” by a trusted brand rather than a trusted physician.

Tingley’s family’s own long-time primary care doctor left the business, she writes, because “the idea of dividing his attention between a computer screen and a patient offended him.” The shift to electronic health records left him flooded with digital documentation work. That efficiency-fueled system, Tingley says, made the process of building relationships with patients “essentially worthless, because doing so is not a finite, billable procedure.”

The work of David Meltzer, a researcher and central figure in the report, however, suggests that investing in that process could have financial benefits not only for the Centers for Medicare and Medicaid Services but for hospital systems themselves.

That’s a point touched on by Ahuja, who actually studied with Meltzer. He says that CMS has traditionally discouraged continuity via its reimbursement protocols, but that could change if the agency sees a financial reason to incentivize relationship-building. Find more about Ahuja’s work at this summary, or head here to download the whole paper.