Small primary care practices have fewer preventable hospital admissions, study finds

While changes in healthcare push small, independent primary care practices toward consolidation and hospital ownership, a new study shows that those practices have fewer preventable hospital admissions.

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The study, published in the August issue of Health Affairs, analyzed survey data from 1,045 practices and compared it to Medicare claims from 999,990 beneficiaries. It found that primary care practices with one to two physicians had 33% fewer preventable hospital admissions than practices with 10 to 19 physicians. Practices with three to nine physicians had 27% fewer admissions compared to larger group practices.

“Our results suggest that the common assumption that bigger is better should not be accepted without question, at least in practices of nine or fewer physicians,” the study’s authors wrote.

The authors called the results “unexpected,” as larger practices tend to have more staff and resources at their disposal to create efficient processes, which are designed to ultimately improve patient care.

“It is possible that small practices have characteristics that are not easily measured but result in important outcomes, such as fewer ambulatory care-sensitive admissions,” the study says. “For example, there is evidence that patients in smaller practices are better able to get appointments when they want them and better able to reach their physician via telephone, compared to larger practices. It is also possible that physicians, patients, and staff know each other better in small practices, and that these closer connections result in fewer avoidable admissions.”

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The authors encourage hospitals and large group practices to examine the benefits of small group practices.

“Small practices have many obvious disadvantages. It would be a mistake to romanticize them. But it might be an even greater mistake to ignore them, and the lessons that might be learned from them, as larger and larger provider organizations clash to gain advantageous positions in the new world of payment and delivery system changes catalyzed by health care reform,” the study concludes.