JAMA: Higher physician spending not linked to better outcomes

Greater spending for healthcare services was not associated with better patient outcomes as measured by 30-day readmissions or mortality rates for hospitalized Medicare patients, according to a study published March 13 in JAMA.

Researchers from Boston's Harvard T.H. Chan School of Public Health, including Yusuke Tsugawa, MD, PhD; Ashish K. Jha, MD; and Joseph P. Newhouse, PhD, coauthored the study. They sought to find out: How much variance in spending occurs between physicians in the same hospital, and do physicians who spend more achieve better patient outcomes?

Here are six things to know about the study.

1. In a retrospective data analysis, the coauthors analyzed a random sample of Medicare fee-for-service beneficiaries 65 years and older who were admitted to the hospital for a nonelective medical condition between 2011 and 2014.

2. First, the coauthors quantified the proportion of variation in Medicare Part B spending attributable to hospitals, physicians and patients. Then they examined the association between physician spending and patient outcomes and compared these measures for physicians within the same hospital.

3. A primary analysis focused on hospitalist physicians, whose patient loads are relatively random since they're based primarily on their work schedules. The researchers included 485,016 hospitalizations treated by 21,963 hospitalists at 2,837 acute care hospitals for this analysis. A secondary analysis focused on general internists overall. This time researchers included 839,512 hospitalizations treated by 50,079 internists at 3,195 acute care hospitals.

4. The researchers calculated physicians' spending levels from 2011 to 2012 and examined patient outcomes between 2013 and 2014 to ensure that the severity of patients' illness did not directly affect physician spending estimates.

5. The study found that variation in spending across physicians within a hospital was more significant than variation in spending when comparing hospitals overall. Notably, higher physician spending was not associated with lower 30-day mortality rates or readmissions for hospitalists or general internists within the same hospital.

6. The authors conclude that these findings suggest policies that target both physician and hospital spending could be more effective in reducing wasteful spending than policies that address hospital spending alone. The authors also note that the study has limitations, including that its analysis focused on only one patient group and therefore its findings may not be generalizable to other populations.

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