A new study published in Health Affairs has found the costs for major medical procedures vary more than twofold across markets, but costs for common chronic conditions are even more disparate — varying by about 15-fold.
The study examined the quality and medical costs for care provided by nearly 250,000 physicians who treated nonelderly UnitedHealthcare-insured patients nationwide from January 2006 through March 2009. The study analyzed physician performance based on 39 months of claims data. Performance assessments were drawn from UnitedHealth's Premium Designation program, which is for physicians who meet or exceed quality standards as measured by more than 300 benchmarks.
The study found "essentially no correlation" between the average costs and the quality of care across markets. For example, in the case of diagnostic cardiac catheterizations, markets with similar quality scores had average costs per episode varying from about $4,000 to $12,000.
Study authors did find 14 percent lower costs per average episode for a portion of physicians across all specialties who had received both quality and cost-efficiency designations, however.
Here are some of the study's other major findings:
• Median episode costs for cervical spine fusion were $26,227. Costs at the 10th percentile were $17,092 while costs at the 90th percentile were $41,431 — 58 percent higher than the median.
• The median episode cost for a migraine was $397. The 10th percentile cost was $94. For the 90th percentile, that cost rocketed to $2,006.
• The median episode cost for asthma was $358. For the 10th percentile, that cost dropped to $98 but grew to $1,535 for the 90th percentile.
• The median episode cost for a decompression of a herniated spinal disk was $10,303. The 10th percentile cost was $7,237 and the 90th percentile cost was $17,680.
• Cardiologists implanting arterial stents who had a quality designation in the UnitedHealth program had a 55 percent lower redo rate and 55 percent lower complication rate compared with other cardiologists.
• Orthopedic surgeons conducting knee arthroscopies who earned a quality designation in the UnitedHealth program had 46 percent less redo surgeries and a 62 percent lower complication rate compared with other orthopedic surgeons.
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The study examined the quality and medical costs for care provided by nearly 250,000 physicians who treated nonelderly UnitedHealthcare-insured patients nationwide from January 2006 through March 2009. The study analyzed physician performance based on 39 months of claims data. Performance assessments were drawn from UnitedHealth's Premium Designation program, which is for physicians who meet or exceed quality standards as measured by more than 300 benchmarks.
The study found "essentially no correlation" between the average costs and the quality of care across markets. For example, in the case of diagnostic cardiac catheterizations, markets with similar quality scores had average costs per episode varying from about $4,000 to $12,000.
Study authors did find 14 percent lower costs per average episode for a portion of physicians across all specialties who had received both quality and cost-efficiency designations, however.
Here are some of the study's other major findings:
• Median episode costs for cervical spine fusion were $26,227. Costs at the 10th percentile were $17,092 while costs at the 90th percentile were $41,431 — 58 percent higher than the median.
• The median episode cost for a migraine was $397. The 10th percentile cost was $94. For the 90th percentile, that cost rocketed to $2,006.
• The median episode cost for asthma was $358. For the 10th percentile, that cost dropped to $98 but grew to $1,535 for the 90th percentile.
• The median episode cost for a decompression of a herniated spinal disk was $10,303. The 10th percentile cost was $7,237 and the 90th percentile cost was $17,680.
• Cardiologists implanting arterial stents who had a quality designation in the UnitedHealth program had a 55 percent lower redo rate and 55 percent lower complication rate compared with other cardiologists.
• Orthopedic surgeons conducting knee arthroscopies who earned a quality designation in the UnitedHealth program had 46 percent less redo surgeries and a 62 percent lower complication rate compared with other orthopedic surgeons.
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