Doing More with Less: Predicting Primary Care Provider Effectiveness

This paper uses data from 802,777 veterans assigned to 7,548 primary care providers (PCPs) within the Veterans Health Administration (VHA) to examine variations in the efficacy of primary care providers (PCPs), their consequences for health outcomes, and their determinants. Leveraging quasi-random assignment of veterans to PCPs, we measure PCP effectiveness along three dimensions: the probability their patients have subsequent hospitalizations for ambulatory care sensitive conditions (ACSC), subsequent hospitalizations or emergency department (ED) visits for mental health conditions, or hospitalizations/ED visits for circulatory conditions. We find a significant range in these measures across PCPs. For example, a one standard deviation improvement in our measure of mental health effectiveness predicts a 0.21 percentage point (3.8%) lower risk of patient death over the next three years and 4.4% lower total costs. We also find that patients whose physicians are better according to one dimension also have better outcomes in terms of the other dimensions we consider. Finally, we find that more effective PCPs do more with less: Their patients have fewer primary care visits, referrals to specialists, lab panels or imaging tests. Effective PCPs are slightly more likely to comply with guidelines for mental health screenings, and slightly less likely to comply with guidelines for physical health screenings, but these differences in screening propensities are negligible in magnitude.