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Increased health care spending not associated with better outcomes

While there was a larger variation in health care expenditures among individual physicians than hospitals, higher physician spending was not associated with better outcomes of hospitalized patients, according to findings published in JAMA Internal Medicine. The researchers suggest that a reduction in wasteful spending may be more achievable with policies focusing on both physicians and hospitals rather than hospitals alone.

“While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians,” Yusuke Tsugawa, MD, MPH, PhD, of the department of health policy and management at Harvard TH Chan School of Public Health, and colleagues wrote. “However, the degree to which spending varies across physicians and the clinical consequences of that variation are unknown.”

To examine the variation in spending across physicians and its association with patient outcomes, Tsugawa and colleagues performed a retrospective data analysis. They used a national sample of Medicare fee-for-service beneficiaries aged 65 years and older hospitalized with and treated for a medical condition by a hospitalist or general internist between Jan. 1, 2011 and Dec. 31, 2014.

For the assessment of hospitalists, they included 485,016 hospitalizations treated by 21,963 physicians at 2,837 acute care hospitals. For the assessment of general internists, they included 839,512 hospitalizations by 50,079 physicians at 3,195 acute care hospitals. Analysis was adjusted for patient and physician characteristics, as well as hospital fixed effects. The researchers evaluated physician spending levels in 2011 to 2012 and their patients’ outcomes in 2013 to 2014 to ensure that physician spending estimates were not directly impacted by illness severity.

Results indicated that variation in spending across hospitals was smaller than across physicians for both hospitalists (7% vs. 8.4%, respectively) and general internists (6.2% vs. 10.5%, respectively). For hospitalists within the same hospital, there was no association between higher physician spending and lower 30-day mortality (adjusted OR for additional $100 in physician spending = 1; 95% CI, 0.98-1.01) or readmissions (aOR = 1; 95% CI, 0.99-1.01). Similar trends were observed among general internists.

“We found substantial variation in spending across physicians practicing within the same hospital that exceeded variation in spending across hospitals,” Tsugawa and colleagues concluded. “Among both hospitalists and general internists, physicians with higher spending per hospitalization had no detectable differences in 30-day mortality or readmissions compared with lower-spending physicians within the same hospital. 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.” – by Alaina Tedesco

Disclosure: The researchers report receiving support from the Office of the Director at NIH and the Abe Fellowship Program.