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    Is your practice’s location financially hurting you?

    Primary care practices located in community settings do a better job of providing high-value, cost-effective services than primary care practices within hospital settings, according to a recent article in JAMA Internal Medicine. The article’s authors examined the extent to which practices in the two different types of locations used low-value services--unnecessary interventions of questionable worth.

     

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    To cite just one of the three types of low-value care that the researchers studied, hospital-based primary care providers were more likely than their community based counterparts to order MRIs or X-rays for patients with back pain or headaches. These kinds of expensive diagnostic studies are uncalled for, according to current guidelines.

    Luci Belnick, MD, independently practices internal medicine in suburban Orlando. However, prior to opening her community-based practice, she practiced for years at a downtown hospital, Orlando Regional Medical Center (ORMC). She described feeing a certain pressure to prescribe imaging studies such as X-rays for back pain while working at ORMC, and ascribed the feeling to the fact that she was practicing in the midst of so many specialists who routinely use the high-tech tools at their disposal.

    In their paper, the researchers reported their findings about the use of specific low-value services often associated with three conditions routinely seen by primary care providers: upper respiratory tract infections (RTIs), back pain and headaches. The low-value services that the researchers studied were the use of CT scans or MRIs for back pain or headaches, (as mentioned above), the use of antibiotics or X-rays for upper RTIs and referrals to specialists for all three conditions.

     

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    The study examined the use of these low-value services following 31,162 primary care visits that took place at either hospital-based outpatient practices or community-based practices. All visits occurred between Jan. 1, 1997 and Dec. 31, 2013.

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