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Higher physician spending doesn’t help hospital patients’ outcomes


A study published in JAMA Internal Medicine found that higher spending on physicians doesn’t lead to better  outcomes for patients who have been hospitalized.

The study included data from a little more than 72,000 physicians over 1,324,000 hospitalizations of Medicare beneficiaries.

The authors found that, perhaps unsurprisingly, spending variation is greater among than physicians than among hospitals.

They said the data “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 point out that many payment-reform and value-based care efforts are targeted to hospitals that, it is assumed, can help influence physician behavior.  They  suggest that this targeting should also directly include physicians,  to help cut  costs.

“Our findings suggest that higher-spending physicians may be able to reduce resource use without compromising patient outcomes. Policy interventions that target physicians within hospitals (e.g., 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.”

“Among both hospitalists and general internists, physicians with higher spending per hospitalization had no detectable differences in 30-day mortality or readmissions compared with lower-spending physicians within the same hospital. 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.”

To read the JAMA piece, please hit this link.

N.C. physicians push for more price transparency


A look at why and how Blue Cross and Blue Shield of North Carolina launched a Web site that lets consumers find the average out-of-pocket cost of many medical procedures. The move was partly instigated by a state transparency law.

The online  database was made available to the general public in January.  Modern Healthcare says that “It covers 1,200 nonemergency procedures, showing the average total of how much the insurer pays particular providers for an episode of care. The figure is drawn from the insurer’s claims data and includes all costs—the discounted payment, physician fees, facility fees, drug and medical supply costs, as well as consumers’ cost-sharing.”

(But what about many emergency procedures?)

The new service  drew criticism  from some high-cost providers and  some consumer advocates, who said the pricing data weren’t adequately explained.So Blue Cross  hopes to improve the tool by “offering additional data on utilization and outcomes patterns for particular providers because price alone doesn’t reveal whether a provider delivers value, ” says Modern Healthcare.

The most interesting part of the tale is that physicians have been among those pushing for more transparency because, as the publication noted, “it would help them as they enter value-based contracts. Internists, for instance, could use the price information to change their referral patterns by looking for high-quality labs or physician specialists offering lower costs.”

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