Higher Physician Spending Does Not Improve Outcomes

Physicians who spend more on expensive tests and procedures have no better 30-day mortality or readmission rates than those who spend less, according to a new study in JAMA Internal Medicine. The retrospective analysis also revealed substantial variation in the amount physicians within the same hospital spend on tests and procedures.

“If you spend more money on a car or a TV, you tend to get a nicer car or a better TV,” said study senior author Anupam B. Jena, MD, PhD, an associate professor of health care policy at Harvard Medical School and physician at Massachusetts General Hospital. “Our findings show that’s not the case when it comes to medical care. Spending more doesn’t always mean you get better health” (JAMA Intern Med. Published online March 13, 2017. doi:10.1001/jamainternmed.2017.0059).

The study investigated how variations in spending among hospitalists and general internists influenced 30-day mortality rates and 30-day readmission rates. Researchers focused on hospitalizations of Medicare fee-for-service patients age 65 and older between 2011 and 2014.

Despite a 40% difference in spending between the highest and lowest quartiles of physicians in the analysis, researchers found no difference in mortality or readmission rates.

The analysis also revealed that spending varied more across physicians within the same hospital than across hospitals. According to the study, 8.4% of the variation in spending could be traced back to differences among individual hospitalists compared with 7% traced back to differences among hospitals.

Researchers concluded that policies to reduce wasteful spending may be more effective if they target both physicians and hospitals rather than focus only on hospitals.

Dr. Jena, however, cautioned against assuming that higher-spending physicians could simply reduce spending without influencing patient outcomes.

“Say you have two painters. One usually takes 2 hours to paint a room, and one takes 6 hours. You can ask the slow painter to hurry up, but you might end up with a room that’s sloppily painted, or with one of the walls the wrong color,” she said. “That’s obviously a situation we want to avoid in health care.”

In an editor’s note, Gregory Curfman, MD, wrote that the study adds “to the growing body of fascinating research on the complex relationship between spending and health.”—Jolynn Tumolo