What’s a piñata got to do with medicine and why should you be concerned? When I think of a piñata, visions of wild swings, candy and prizes flying in all directions, and children frantically grabbing for as much as they can get hold of before someone else gets it.  It is doubtful that you have ever looked at it from a piñata’s perspective, right? Well, as a patient of hospital-based primary care, it turns out, you may have experienced firsthand what it feels like to be a piñata. 

So how does the “piñata effect” apply to you, the patient? According to a study published April 10, 2017 in JAMA Internal Medicine, authors posit that hospital-based practices deliver more low-value care than community-based practices. What this means, according to their research, is hospital-based primary care visits are more likely to whack you like a piñata, and grab as much money from you or your insurer (the piñatas) as possible. In this study, hospital-based primary care was shown to have a higher use of imaging, and more than double the rate of referrals to specialist, when compared to community based practices. 

Being sick is never fun; and I’ll hazard a guess that footing the bill for overuse or overtreatment is not the kind of party patients were looking for from hospital-based primary care. To be fair to the providers who have sold their souls to St Luke’s or Saint Al’s (joking of course), practice patterns in community-based practices, regardless of ownership (independent or hospital owned), were similar in most respects. Interestingly though, the study did show that hospital-owned community-based practices were more likely to refer patients to specialists than independently owned practices.

The study seems to coincide with others that have shown that higher costs associated with integrated care do not equate to more efficient or higher quality care. Interestingly, the authors pointed out, the higher use of imaging and referrals to specialist seemed to be related with visits to physicians that were not the patients primary care provider. That piece of information is, in my opinion, one of the most valuable insights provided by this study.  It underscores, an already well known conclusion, that patients can increase their quality of care, and lower their medical costs by following up with their primary care provider regularly…  Have you seen you your primary care provider recently? 

In closing, I did Google the “piñata effect” prior to writing this. While I am not the first to coin the phrase, it does appear, after skimming the first page of results, that I am the first to apply it to medicine! Let it be known, if that’s the case, I’ll certainly take credit for it when phrase catches on.