Agha Leila, Ericson Keith Marzilli, Geissler Kimberley H, Rebitzer James B
Dartmouth College and NBER.
Boston University's Questrom School of Business and NBER.
Manage Sci. 2022 May;68(5):3175-3973. doi: 10.1287/mnsc.2021.4091. Epub 2021 Sep 8.
We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals-for instance, by sending their cardiology patients to fewer distinct cardiologists-repeat interactions between PCPs and specialists are encouraged. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with a one standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.
我们研究了基层医疗医生（PCP）将患者转诊给专科医生时形成的团队。当基层医疗医生集中他们的专科转诊时——例如，通过将他们的心脏病患者转诊给更少的不同心脏病专家——就会鼓励基层医疗医生和专科医生之间的反复互动。反复互动为发展富有成效的团队关系提供了更多机会和激励。利用来自马萨诸塞州全支付者索赔数据库的数据，我们构建了一种新的基层医疗医生团队转诊集中度衡量指标，并记录到它在不同的基层医疗医生之间差异很大，即使是在同一组织内的基层医疗医生中也是如此。由团队转诊集中度高出一个标准差的基层医疗医生治疗的慢性病患者，平均医疗保健利用率低4%，而质量没有明显下降。我们使用医疗保险索赔的全国样本证实了这一发现，并表明在考虑了观察到的和未观察到的患者及医生特征的各种识别策略下，这一发现仍然成立。结果表明，基层医疗医生与专科医生之间的反复互动提高了团队绩效。
