Measuring the Value of High-Quality Primary Care: Evidence from Medicare

Unlike other service sectors such as education, there have been relatively few attempts to evaluate the quality of services that patients receive from health care professionals. The reluctance to measure health care provider quality generally originates from a lack of consensus about what providers should do for their patients. However, in recent years, professional board certifying organizations, the U.S. government, and organizations of health care professionals have published guidelines for best clinical practices for primary care providers who supply preventive care and who also diagnose and treat chronic conditions (e.g., heart disease, diabetes, mental health). In this project, we combine data on guidelines for best clinical practices with Medicare claims data to measure how often primary care physicians adhere to the guidelines (our measure of “physician quality”). We compare adherence rates across physicians and we show how adherence rates vary across the country. Next, we identify sets of physicians who move from one location to another, and we observe where their patients receive care after they move. We take the difference in estimated "physician quality'' between the physicians who moved and the physicians who subsequently treat the moving physicians' patients. Finally, we evaluate the patients' outcomes in the 1-3 years after the physicians move, and determine whether patients who ended up with relatively higher quality physicians after the move had better outcomes (as measured by fewer preventable hospitalizations, lower mortality, and higher likelihood of receiving care that conforms to the best clinical practice guidelines). Thus, by using physician movers, we exploit a plausibly exogenous change in physician practice styles that might explain differences in patient health outcomes.