COST OF CARE AND PATIENT-SATISFACTION FROM ROUTINE REFERRAL TO NONSURGICAL MUSCULOSKELETAL SPECIALISTS IN A MEDICARE RISK PLAN

We evaluated the impact of a Musculoskeletal Consultation System (MCS) in which primary care physicians (PCPs) referred patients with muscul oskeletal conditions to rheumatologists or a skilled internist. Three high cost service areas using the new referral pattern were compared w ith five control service areas within a Medicare risk health plan tota l service area from 1992 though 1994. PCPs referred to an MCS physicia n when specialty consultation or high cost diagnostic evaluations were desired. PCPs in the five control hospitals continued usual referral patterns. The health plan's claims reports provided cost and utilizati on outcome data. Total musculoskeletal care costs attributable to MCS physicians, orthopedic physicians, outpatient physical therapy (PT), a nd musculoskeletal radiology were reduced 32% during 2 years. The numb er of total knee and hip replacements decreased 55%, compared with no change in control areas. Our experience suggests that referring to non surgical musculoskeletal care specialists leads to a reduction in the cost of care for musculoskeletal conditions, compared with the usual P CP's referral care.