Higher physician spending not associated with lower admission rates
- Higher physician spending among hospitalists and general internists was not associated with lower 30-day mortality rates or readmissions, a new study published in JAMA Internal Medicine found.
- Healthcare spending varied more across individual physicians than hospitals, the researchers found.
- "Given larger variation in spending across physicians than across hospitals, policies that target physicians within hospitals may be more effective in reducing wasteful spending than policies focusing solely on hospitals," the researchers concluded.
The study authors set out to examine physician spending and its associations with patient outcomes. They noted that healthcare spending across hospital regions vary yet state physicians are often the key decision makers for treatments.
The study included data from a little more than 72,000 physicians over 1,324,000 hospitalizations of Medicare beneficiaries.
Taken together, these findings that spending variation is greater among than physicians than hospitals and that higher spending is not associated with patient outcomes "suggest that not only does physician spending vary substantially even within the same hospital, but also that higher-spending physicians do not reliably achieve better patient outcomes," the authors wrote.
Many payment reform and value-based care efforts are targeted to hospitals that, it is assumed, can help influence physician behavior, as the authors point out. However, taking the findings, the authors suggest such policies could target physicians as well as hospitals to help drive down healthcare costs.
"Our findings suggest that higher-spending physicians may be able to reduce resource use without compromising patient outcomes," the authors wrote. "Policy interventions that target physicians within hospitals (eg, physician-level pay-for-performance programs and reporting of how resource use of each physician compares with other physicians within the same hospital) should be developed and evaluated."
One of the study authors, Dr. Ashish Jha, K.T. Li Professor of Health Policy at the Harvard T.H. Chan School of Public Health and director of the Harvard Global Health Institute, recently told Healthcare Dive that hospital administrators need to be flexible and expect big changes in the alternative payment model space as the evidence is still out much much they work/save money. He noted experimentation in such models is needed and will likely happen. To that end, physicians may need to be ready to react if new healthcare spending policies do target both physicians and hospitals.
Follow Jeff Byers on Twitter