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- Title
Physician Prices and Low-Value Services: Evidence From General Internal Medicine.
- Authors
Bond, Amelia M.; Yongkang Zhang; Toscano, Fabrizio; Manyao Zhang; Johnson, Phyllis; Yuting Qian; Unruh, Mark Aaron; Casalino, Lawrence P.
- Abstract
OBJECTIVES: To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services. STUDY DESIGN: Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers. METHODS: The main outcome was count of 19 potential low-value services in 2014. The secondary outcome was total spending on the low-value services. Independent variables of interest were price quintiles based on each physician's mean geographically adjusted price of a mid-level office visit, the most commonly billed service by general internal medicine (GIM) physicians. We estimated the association between physician price quintile and provision of low-value services via negative binomial or generalized linear models with adjustments for measure, region, and patient and physician characteristics. RESULTS: This study included 750,452 commercially insured patients attributed to 28,951 GIM physicians. In 2014, the mean geographically adjusted price for physicians in the highest price quintile was $122.6 vs $54.7 for physicians in the lowest quintile ($67.9 difference; 95% CI, $67.5-$68.3). Relative to patients attributed to the lowestpriced physicians, those attributed to the highest-priced physicians received 3.6, or 22.9%, fewer low-value services per 100 patients (95% CI, 2.7-4.7 services per 100 patients). Spending on low-value services attributed to the highestpriced physicians was 10.9% higher ($520 difference per 100 patients; 95% CI, $167-$872). CONCLUSIONS: Commercially insured patients of high-priced physicians received fewer low-value services, although spending on low-value services was higher. More research is needed to understand why high-priced providers deliver fewer low-value services and whether physician prices are correlated with other measures of quality.
- Subjects
INSURANCE companies; INTERNAL medicine; SCIENTIFIC observation; CONFIDENCE intervals; MEDICAL care costs; VALUE-based healthcare; HEALTH insurance reimbursement; USER charges; DESCRIPTIVE statistics; PHYSICIANS
- Publication
American Journal of Managed Care, 2022, Vol 28, Issue 5, pe178
- ISSN
1088-0224
- Publication type
Article
- DOI
10.37765/ajmc.2022.89149