A study in the September/October Annals of Family Medicine indicates there is a relationship between extended office hours in medical practices and lower health care costs. But, study researchers concluded that it is not clear whether the extended hours themselves account for lower medical costs or whether the extended hours are indicative of practices that generally do a good job of controlling expenditures.
"Extended Office Hours and Health Care Expenditures: A National Study(annfammed.org)" was conducted by researchers at the Center for Healthcare Policy and Research at the University of California Davis School of Medicine. The researchers analyzed data from 30,714 patients surveyed for the Medical Expenditure Panel Survey between 2000 and 2008 and compared patients who had access to extended office hours with patients who did not.
The study found that patients whose usual source of care offered extended hours by remaining open during evening and weekend hours had less use of and lower associated expenditures for office visits, prescription medications, emergency department visits and hospitalizations than patients without such access. Researchers defined the "usual source of care" as primary care practices; urgent care centers were excluded because these facilities do not serve as a patient's usual source of care.
Overall, total health care expenditures for patients with extended access to their primary care professional were 10.4 percent lower than for patients without expanded access, according to the study.
"Because there are competing explanations, I don't think you can say that our findings mean that all primary care practices should offer extended hours as a way of lowering costs," said Anthony Jerant, M.D., professor of family and community medicine at the University of California Davis School of Medicine and lead author of the study. "We need to study this more. We need to tease out and answer the question of whether offering extended hours makes a difference in cost, or is it a way of identifying practices that already are practicing in a cost-effective way."
Jerant said the study findings point more strongly toward the explanation that extended hours are indicative of practices that "generally have cost-effective approaches to health care."
Although extended hours were associated with fewer emergency room visits, this did not account for the lower total expenditures associated with extended hours, said Jerant. Moreover, he added, extended office hours would not explain why prescription drug costs and costs associated with office visits were lower in the study for patients with expanded access.
The findings imply that offices offering extended hours may be more cost-effective prescribers and may order fewer or less expensive tests, Jerant said. "This would make sense because offering extended hours is being promoted as part of a bundle of services in the patient-centered medical home, for example, (which) could lower health care costs."
The study, meanwhile, did not find a relationship between extended hours and mortality, a finding that came as a relief to Jerant and other researchers. "Our concern was that if a practice offers extended hours, patients may be showing up in the practice who should be going to the emergency room and, therefore, could have a higher mortality rate," said Jerant. "We didn't see that, which is reassuring."