Background Primary care physicians are expected to coordinate care for their patients. Objective Assess the number of physician peers providing care to the Medicare patients of a primary care physician Design Cross-sectional analysis of claims data Setting Fee-for-service Medicare in 2005 Participants 2,284 primary care physicians who responded to the 2004-2005 Community Tracking S (CTS) Physician Survey. Measurements Primary patients for each physician identified as beneficiaries for whom the physician billed for more evaluation and management visits than any other physician in 2005. The number of physician peers for each physician was the sum of 1) other unique physicians that the index physician's primary patients visited, and 2) other unique physicians who served as the primary physician for each of the index physician's non-primary patients during 2005. Results The typical primary care physician has 229 (IQR125-340) other physicians working in 117 (IQR66-175) different practices with whom care would have to be coordinated, equivalent to an additional 99 physicians and 53 practices for every 100 Medicare beneficiaries managed by the primary care physician. Considering only the 31% of a primary care physician's primary patients who had 4 or more chronic conditions, the number of peers was still substantial [86 physicians in 36 practices]. The number of peers varied with geographic region, practice type, and reliance on Medicaid revenues. Limitations Estimates are based on only fee-for-service Medicare patients and physician peers, and therefore likely undercount the number of peers. The modest response rate of the CTS survey may bias results in unpredictable directions. Conclusion In caring for his or her own primary and non-primary patients over one year, each primary care physician potentially must coordinate with a large number of individual physician colleagues who also provide care to these patients.

Although results are based on measured associations between malpractice fears and spending, and may not reflect the true causal effects, they suggest defensive medicine likely contributes substantial additional costs to Medicare.

Objective. To identify factors associated with the cost of treating high‐cost Medicare beneficiaries. Data Sources. A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004–2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. Study Design. Using 12 months of claims data from 2005 to 2006, the sample was divided into predicted high‐cost (top quartile) and lower cost beneficiaries using a risk‐adjustment model. For each group, total annual standardized costs of care were regressed on beneficiary, usual source of care physician, practice, and market characteristics. Principal Findings. Among high‐cost beneficiaries, health was the predominant predictor of costs, with most physician and practice and many market factors (including provider supply) insignificant or weakly related to cost. Beneficiaries whose usual physician was a medical specialist or reported inadequate office visit time, medical specialist supply, provider for‐profit status, care fragmentation, and Medicare fees were associated with higher costs. Conclusions. Health reform policies currently envisioned to improve care and lower costs may have small effects on high‐cost patients who consume most resources. Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for “bending the cost curve.”

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Timely administration of appropriate antibiotic therapy is associated with better patient outcomes and lower costs of care compared to delayed appropriate therapy, yet initial treatment is often empiric since causal pathogens are typically unknown upon presentation. The challenge for clinicians is balancing selection of adequate coverage treatment regimens, adherence to antimicrobial stewardship principles to deter resistance, and financial constraints. This retrospective cohort study aimed to assess the magnitude and impact of delayed appropriate antibiotic therapy among patients hospitalized with septic arthritis (SA) in the U.S. from 2017 to 2019 using healthcare encounter data. Timely appropriate therapy was defined as the receipt of antibiotic(s) with in vitro activity against identified pathogens within two days of admission; all other patients were assumed to have received delayed appropriate therapy. Of the 517 patients admitted to hospital for SA who met all selection criteria, 26 (5.0%) received delayed appropriate therapy. In inverse-probability-treatment-weighting-adjusted analyses, the receipt of delayed appropriate therapy was associated with an additional 1.1 days of antibiotic therapy, 1.4 days in length of stay, and $3531 in hospital costs (all vs. timely appropriate therapy; all p ≤ 0.02). Timely appropriate therapy was associated with a twofold increased likelihood of antibiotic de-escalation during the SA admission.