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Is higher health care spending by physicians associated with better outcomes?

March 13, 2017

Higher health care utilization spending by physicians was not associated with better outcomes for hospitalized Medicare beneficiaries in a new article published online by JAMA Internal Medicine.

The article by Yusuke Tsugawa, M.D., M.P.H., Ph.D., of the Harvard T.H. Chan School of Public Health, Boston, and coauthors examined variation in spending across physicians' adjusted Medicare Part B spending levels and its association with patients' 30-day mortality and readmission rates.

The authors used a random sample of Medicare fee-for-service beneficiaries who were hospitalized with a nonelective medical condition between 2011 and 2014. The primary analysis focused on hospitalist physicians and a secondary analysis focused on general internists. Physician spending levels were calculated in 2011 through 2012 and patient outcomes were examined in 2013 and 2014 so the severity of a patient's illness did not directly affect physician spending estimates.

The authors report health care spending varied more across individual physicians than across hospitals and, among hospitalized patients, higher spending by physicians was not associated with lower 30-day mortality or 30-day readmissions.

The study has limitations, including that its analysis was restricted to hospitalized Medicare patients so the results may not be generalizable to other patient groups.

"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," the article concludes.
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(JAMA Intern Med. Published online March 13, 2017. doi:10.1001/jamainternmed.2017.0059; available pre-embargo at the For The Media website.)

Editor's Note: The article contains conflict of interest and funding/support disclosures. Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

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