Relationship between primary care physician financial risk and member emergency department use in a commercial HMO population.
OBJECTIVE
To demonstrate whether, despite factors beyond the control of primary care physicians (PCPs), health maintenance organization (HMO) members under the care of PCPs with greater financial risk for the cost of emergency care have lower rates of emergency department use.


METHODS
Cohort study using calendar year 2000 administrative data on 217 298 commercial members enrolled in a nonprofit statewide HMO (Blue Care Network of Michigan) under the care of non-staff-model PCPs with varying levels of financial risk for emergency care.


METHODS
Ordinary least squares (OLS) and binary logistic regression models were developed to assess the influence of PCP financial risk, net effects of member and PCP demographics, and emergency care accessibility on use of emergency treat-and-release services by members.


RESULTS
OLS results indicated emergency use was lower by 33 visits per 1000 (P < .001) and 51 visits per 1000 (P < .001) for members with PCPs who had medium and high financial risk, respectively, compared with members whose PCPs had low financial risk for emergency care. Emergency care availability, member copayment and demographics, and the number of all Blue Care Network members assigned to the PCP also were significant predictors of emergency use.


CONCLUSIONS
PCPs do have the ability to influence their patients' emergency department use if financially motivated to do so. Ensuring that the PCP has a large enough number of patients under a specific contractual arrangement also is an important component of the success of an associated financial incentive.
Goodman
Robert M
RM
Blue Care Network of Michigan, Mail Code C336, 20500 Civic Center Dr, Southfield, MI 48076, USA. rgoodman@bcbsm.com
D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006801:Humans; D008824:Michigan; D010820:Physicians / Q000191:economics*; D011320:Primary Health Care; D018570:Risk Assessment