A Quantitative Observational Study of Physician Influence on Hospital Costs.
INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018;
55:46958018800906. [PMID:
30264626 PMCID:
PMC6166308 DOI:
10.1177/0046958018800906]
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Abstract
Physicians serve as the nexus of treatment decision-making in hospitalized
patients; however, little empirical evidence describes the influence of
individual physicians on hospital costs. In this study, we examine the extent to
which hospital costs vary across physicians and physician characteristics. We
used all-payer data from 2 states representing 15 237 physicians and 2.5 million
hospital visits. Regression analysis and propensity score matching were used to
understand the role of observable provider characteristics on hospital costs
controlling for patient demographics, socioeconomic characteristics, clinical
risk, and hospital characteristics. We used hierarchical models to estimate the
amount of variation attributable to physicians. We found that the average cost
of hospital inpatient stays registered to female physicians was consistently
lower across all empirical specifications when compared with male physicians. We
also found a negative association between physicians’ years of experience and
the average costs. The average cost of hospital inpatient stays registered to
foreign-trained physicians was lower than US-trained physicians. We observed
sizable variation in average costs of hospital inpatient stays across medical
specialties. In addition, we used hierarchical methods and estimated the amount
of remaining variation attributable to physicians and found that it was
nonnegligible (intraclass correlation coefficient [ICC]: 0.33 in the full
sample). Historically, most physicians have been reimbursed separately from
hospitals, and our study shows that physicians play a role in influencing
hospital costs. Future policies and practices should acknowledge these important
dependencies. This study lends further support for alignment of physician and
hospital incentives to control costs and improve outcomes.
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