Abstract
BackgroundPrevious studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere. Our objective was to compare patterns of healthcare utilization between Medicare beneficiaries who received primary care from FQHCs and Medicare beneficiaries who received primary care from another source.MethodsWe compared characteristics and ambulatory, emergency department (ED), and inpatient utilization during 2013 between 130,637 Medicare beneficiaries who visited an FQHC for the majority of their primary care in 2013 (FQHC users) and a random sample of 1,000,000 Medicare fee-for-service (FFS) beneficiaries who did not visit an FQHC (FQHC non-users). We then created a propensity-matched sample of 130,569 FQHC users and 130,569 FQHC non-users to account for differences in observable patient characteristics between the two groups and repeated all comparisons.ResultsBefore matching, the two samples differed in terms of age (42% below age 65 for FQHC users vs. 16% among FQHC non-users, p < 0.001 for all comparisons), disability (52% vs. 24%), eligibility for Medicaid (56% vs. 21%), severe mental health disorders (17% vs. 10%), and substance abuse disorders (6% vs. 3%). FQHC users had fewer ambulatory visits to primary care or specialist providers (10.0 vs. 12.0 per year), more ED visits (1.2 vs. 0.8), and fewer hospitalizations (0.3 vs. 0.4). In the matched sample, FQHC users still had slightly lower utilization of ambulatory visits to primary care or specialist providers (10.0 vs. 11.2) and slightly higher utilization of ED visits (1.2 vs. 1.0), compared to FQHC users. Hospitalization rates between the two groups were similar (0.3 vs. 0.3).ConclusionsIn this population of Medicare FFS beneficiaries, FQHC users had slightly lower utilization of ambulatory visits and slightly higher utilization of ED visits, compared to FQHC non-users, after accounting for differences in case mix. This study suggests that FQHC care and non-FQHC care are associated with broadly similar levels of healthcare utilization among Medicare FFS beneficiaries.
Highlights
Previous studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere
Differences in these study outcomes relate in part to the segment of the population that was the focus of the study, in part to the time period studied, and in part to the extent that they controlled for important differences between FQHC users and FQHC non-users
FQHC users were significantly more likely than FQHC non-users to be under 65 years old (42% vs. 16%, p < 0.001 for this and all other comparisons ), non-White (32% vs. 15%), disabled (52% vs. 24%), and Medicaid-eligible (56% vs. 21%)
Summary
Previous studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere. Our objective was to compare patterns of healthcare utilization between Medicare beneficiaries who received primary care from FQHCs and Medicare beneficiaries who received primary care from another source. Qualified health centers (FQHCs) receive federal funding to provide comprehensive primary care in underserved communities. Three-quarters of the 20 million patients seen at FQHCs annually have incomes below the federal poverty level (FPL), and more than half are members of a racial or ethnic minority group [1]. Studies of FQHCs have consistently shown that they provide high quality primary care, but the results of research examining the overall healthcare utilization patterns of FQHC users have been mixed. Differences in these study outcomes relate in part to the segment of the population that was the focus of the study (e.g., younger patients, older patients, dual eligible patients), in part to the time period studied (since these studies span almost two decades), and in part to the extent that they controlled for important differences between FQHC users and FQHC non-users
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