Public Policy

Variation in physician spending and association with patient outcomes


Title: Variation in physician spending not associated with patient outcomes

Clinical Question: Is there a variation in spending between physicians in the same hospital, and does it have an effect on patient outcomes?

Background: Not much is known about the presence of variations in individual physician spending within the same hospital and it is not known if higher-spending physicians have better patient outcomes compared to peers within the same institution.

Dr. Alexander Rankin, a hospitalist and director of the family medicine residency inpatient service at the University of New Mexico
Dr. Alexander Rankin
Study Design: Retrospective data analysis.

Setting: National sample of hospitalized Medicare beneficiaries.

Synopsis: Using National Medicare data over a 4-year period, the authors showed that there is wide variation in Part B spending across physicians (hospitalists and general internists) within the same acute care hospital. This inter-physician variation is larger than the difference in spending across hospitals. Higher spending was not associated with a reduction in 30-day mortality or 30-day readmission rates.

Most current health reform policies such as value-based purchasing and 30-day readmission penalties target hospitals as entities, but based on this study there may be a role for more physician-specific reform options. Because they found no significant difference in quality outcomes based on spending, the authors postulate that there may be an opportunity for individual high-spending physicians to decrease their health care utilization without compromising care quality.

The major limitation to this study is that it is a large-scale data analysis and may not capture some of the intricacies of individualized patient care.

Bottom Line: Spending varies across physicians within the same hospital, and is not associated with differences in mortality or readmissions outcomes.

Citation: Tsugawa Y, Jha AK, Newhouse JP, Zaslavsky AM, Jena AB. Variation in Physician Spending and Association With Patient Outcomes. JAMA Intern Med. 2017. doi: 10.1001/jamainternmed.2017.0059.

Dr. Rankin is a hospitalist and director of the family medicine residency inpatient service at the University of New Mexico.

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