Saturday, November 24, 2012

Physicians With The Least Experience Have Higher Cost Profiles Than Do Physicians With The Most Experience - Health Affairs

Physicians With The Least Experience Have Higher Cost Profiles Than Do Physicians With The Most Experience - Health Affairs

This article has gotten a lot of press in that it touches so many buttons - cost, experience and the status of things for young physicians. It has attracted the attention of insurance companies, the government and the lay press.

A cost profile is a case-mix adjusted measure of resource use in comparison to that of a peer group.  This study of costs/episode of treatment was based on inpatient and outpatient costs regarding over 1,000,000 patients aged 18-65 and over 12,000 physicians who rendered over 2,800,000 episodes of treatment (average 236/physician) in 2004-2005.  This study included the full range of physician specialties; orthopaedic surgeons comprised 4.6% of all physicians rendering 2.4% of all episodes and having 125 episodes/physician.

Compared to physicians with 40 or more years of experience, physicians with fewer than 10 years, 20–29 years, and 30–39 years of experience had 13.2 percent, 10.0 percent, 6.5 per- cent, and 2.5 percent higher cost-profile scores, respectively. Higher volume physicians had somewhat lower cost-profiles. Just as for episode-based costs,  mean per capita patient costs were lower for more experienced physicians: $14,906 for physicians with fewer than 10 years of experience, $15,623 for those with 10–19 years, $14,066 for those with 20–29 years, $12,028 for those with 30–39 years, and $10,104 for those with more than 40 years.

The authors suggest that as a result of this finding, physicians with less experience are more likely to be negatively impacted by policies that implement cost profiles, for example by receiving lower payments under Medicare's 'value based' system or by being excluded from certain provider networks or insurance plans.  

While the reasons behind these differences in cost profiles are not identified in this study, this research does call attention to the fact that cost profile methodology is in place and that payers of health care will be collecting and using these data. It is important, therefore, that as providers - whether young or old -  we are equally aware of these metrics and consider them in our decision making regarding the ordering of more expensive tests and implants unless there is clear benefit to our patients.


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