US physicians: "less enthusiasm for cost containment involving changes in payment models"

http://www.ncbi.nlm.nih.gov/pubmed/23917288

JAMA. 2013 Jul 24;310(4):380-8. doi: 10.1001/jama.2013.8278.

Views of US physicians about controlling health care costs.

Tilburt JC, Wynia MK, Sheeler RD, Thorsteinsdottir B, James KM, Egginton JS, Liebow M, Hurst S, Danis M, Goold SD.

Source

Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. tilburt.jon@mayo.edu

Erratum in

• JAMA. 2013 Aug 28;310(8):857.

Abstract

IMPORTANCE:

Physicians' views about health care costs are germane to pending policy reforms.

OBJECTIVE:

To assess physicians' attitudes toward and perceived role in addressing health care costs.

DESIGN, SETTING, AND PARTICIPANTS:

A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.

MAIN OUTCOMES AND MEASURES:

Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.

RESULTS:

A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the "uncertainty involved in patient care disconcerting" was negatively associated with cost-consciousness (β = -1.95; 95% CI, -2.71 to -1.18; P < .001).

CONCLUSION AND RELEVANCE:

In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.