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- Title
Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts.
- Authors
Sahni, Nikhil R.; Marine, Crosbie; Cutler, David M.; Medford-Davis, Laura N.; Mezue, Melvin; Kattan, Omar; Levine, Ed; Joynt Maddox, Karen E.
- Abstract
This survey study assesses clinician views on the feasibility of site-of-care shifts from the hospital to alternative care settings and estimates potential net savings that would be associated with these shifts. Key Points: Question: Based on clinician views, how much care from the hospital could be shifted to alternative sites without compromising clinical outcomes, and what would be the associated net savings? Findings: In this survey study of 1069 clinicians surveyed in 2021 and historical claims data from 2019, 10.3 percentage points of commercial and 10.9 percentage points of Medicare volume could be shifted from the hospital to alternative sites using today's technology without compromising clinical outcomes. Based on observed reimbursement rates, this would be associated with savings of $113.8 billion (3.2%) to $147.7 billion (4.1%) in 2019 dollars annually for the overall US health care system. Meaning: These findings suggest that while a substantial net savings opportunity may remain from site-of-care shifts, ongoing alignment among organizations, clinicians, and policymakers is needed to ensure the best outcomes for patients. Importance: Shifting care to alternative sites when clinically appropriate may be associated with reduced US health care spending, improved access, and, in some cases, improved care outcomes. Objective: To fill 2 main gaps in the current literature on site-of-care shifts: (1) understanding the clinician perspective on appropriateness of alternative care sites, given the central role they play in referrals and patient trust and (2) considering all potential sites where care could shift and calculating net savings potential. Design, Setting, and Participants: In this survey study, physicians (MDs and DOs), nurse practitioners, physician assistants, nurse anesthetists, radiology and imaging technicians, and psychologists were surveyed from September 17 to November 22, 2021, about potential shifts of care from the hospital setting to alternative sites. Participants were selected by the survey firm Intellisurvey to provide broad representation across all specialties of interest. A minimum of 34 clinicians responded to each question. Data were analyzed from April 2022 through October 2023. Exposure: More than 5000 individual diagnostic and procedural codes were reviewed and sorted into 312 distinct care activities by an expert panel of physicians. Survey respondents were then provided with the 2019 claims-based distribution across sites of care for each care activity and were asked, "based on your clinical judgment, what portion of [care activity] could safely occur in each of the following sites of care, without compromising clinical outcomes?" Main Outcomes and Measures: Based on clinician-reported distributions, the total potential shift of volume from hospital-based settings to alternative sites and the associated net savings were estimated. Results: Survey respondents included 1069 practicing clinicians (386 female [36.1%]; mean [SD] years since residency of physicians, 21.0 [9.7] years; mean [SD] age of nonphysicians, 45.3 [9.4] years) across specialties, all of whom practiced more than 20 clinical hours per week. There were 794 physicians (74.3%), and the remaining 275 respondents were midlevel professionals, such as physician assistants. Among 312 care activities surveyed, respondents indicated that 10.3 percentage points (95% CI, 10.0-10.5 percentage points) of commercial and 10.9 percentage points (95% CI, 10.7-11.1 percentage points) of Medicare volume currently taking place in hospital-based settings could shift to alternative sites with today's technology without compromising clinical outcomes. Across the entire US health care system, these shifts could be associated with a reduction in overall health care consumption spending ($3 562 339 000 000 000) by approximately $113.8 billion ($113 767 446 087 174 [3.2%]) to $147.7 billion ($147 661 672 284 263 [4.1%]) annually. Conclusions and relevance: In this study, a substantial net savings opportunity was estimated. However, realizing this potential will require ongoing alignment among organizations, clinicians, and policymakers to overcome barriers to these shifts.
- Subjects
UNITED States; COST control; RESEARCH funding; MEDICAL care; HEALTH policy; MEDICARE; EVALUATION of medical care; CHI-squared test; DESCRIPTIVE statistics; TRANSITIONAL care; SURVEYS; ATTITUDES of medical personnel; CONFIDENCE intervals; MEDICAL care costs
- Publication
JAMA Network Open, 2024, Vol 7, Issue 8, pe2426857
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.26857