Physicians Surveyed about Strategies to Contain Costs

Strategies suggested to curb increasing healthcare costs in the United States often focus on physicians, calling for reductions in waste and increased conservative stewardship of resources. Noting the importance of physicians’ perspectives on policies and strategies related to cost reductions as well as their perceived role as stewards of healthcare resources, researchers recently conducted a survey of physicians in the United States to identify their views on pending and proposed policies and strategies aimed at controlling healthcare costs. The survey also asked about physicians’ perceptions on their role in the cost-containment efforts.

The researchers selected a simple random sample of 3897 physicians from the American Medical Association Physician Masterfile. The selected survey recipients were currently practicing and represented all specialties. Residents, those whose primary specialty was identified as administration only, and those >65 years of age, were excluded. The 8-page, self-administered survey was mailed in late May, June, and July 2013, using the Tailored Design Method, which included a $20 bill with the first mailing. Nonresponders received second and third mailings at 6-week intervals.

Survey results were reported in JAMA [2013;310(4):380-388]. The main outcome measures of survey responses were enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale referenced in the survey. Rate of response was 65% (n=2556 respondents).

When asked to quantify stakeholder responsibility for controlling costs, the physicians described trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), and pharmaceutical and device manufacturers (56%) as having “major responsibility” for reducing healthcare costs. Ninety-eight percent of respondents said that patients have either a major (52%) or some (46%) responsibility.

The respondents indicated that practicing physicians were relatively less responsible for containing costs (36% major, 59% some), as were employers (19% major, 63% some), and physician professional societies (27% major, 61% some).

When asked about various cost-containment strategies to reduce healthcare costs, the respondents expressed a high degree of enthusiasm for interventions that improve quality of care; for example, 75% were “very enthusiastic” and 23% were “somewhat enthusiastic” about efforts designed to promote continuity of care. Ninety percent were very or somewhat enthusiastic about improving conditions for evidence-based decisions, such as “expanding access to quality and safety data,” “promoting head-to-head trials of competing treatments,” and “limiting corporate influence on physician behavior.”

There were more mixed ratings for changing the model for reimbursement. There was relatively strong support for strategies such as “limiting access to expensive treatments with little net benefit (51% very enthusiastic, 38% somewhat enthusiastic) and using cost-effectiveness data to determine available treatments (47% very enthusiastic, 42% somewhat enthusiastic).

Other strategies such as penalizing providers for avoidable readmissions and bundled payment plans received less support (59% and 65% not enthusiastic, respectively). Strategies that potentially involve reducing payment to physicians directly (eliminating fee-for-service payment models and reducing compensation for the highest-paid specialties) received far less support (70% and 44% not enthusiastic, respectively).

Most of the physicians (76%) said they were “aware of the costs of the test/treatments [they] recommend,” 78% agreed they “should be solely devoted to individual patients’ best interests, despite the expense,” 79% said they should adhere to clinical guidelines that discourage the use of marginally beneficial care, and 89% agreed that physicians “need to take a more prominent role in limiting use of unnecessary tests.”

In summary, the researchers said, “In this survey about healthcare cost containment, US physicians reported having some responsibility in addressing healthcare costs in their practice and expressed general agreement about several quality initiatives to reduce costs, but reported less enthusiasm for cost-containment efforts involving changes in payment models.”