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High-income docs with Medicare patients highly rewarded for procedures, study finds

CT scan
“Advising a patient that she does not need a computed tomography scan often takes more skill and time, and may represent higher quality of care than ordering a scan or performing a service.”

Doctors with the highest incomes from treating Medicare patients tend to make more money from the procedures they order than from the number of patients they see, according to a “research letter” report published Monday in JAMA Internal Medicine.

This finding adds support to those who say we need to revamp our pay-for-service model of delivering health care if we want to keep medical costs under control.

It also adds to growing concerns about the extent to which patients are receiving unnecessary — and potentially harmful — testing and treatment.

“Our findings suggest a weakness in fee-for-service medicine,” Dr. Jonathan Bergman, one of the authors of the study and an assistant professor of urology and family medicine at UCLA’s David Geffen School of Medicine, told reporters. “Perhaps it would make more sense to reimburse clinicians for providing high-quality care, or for treating more patients.”

For the study, Bergman and his colleagues at UCLA and at the Los Angeles Veterans’ Health Administration analyzed data on Medicare Part B payments (which cover medical services and supplies) to physicians in 2012. The data revealed, they write, “tremendous overall variation in the number of services offered each [Medicare] beneficiary.”

After dividing the doctors into 10 groups based on how much money they earned from Medicare, the researchers found that the procedure-to-patient ratio was five times higher among the doctors in the top-earning group than among those in the lowest-earning one.

No evidence of improved care

As Bergman and his colleagues point out in their paper, those additional services may or may not contribute to improved quality of care.  “For instance,” they write, “advising a patient that she does not need a computed tomography scan often takes more skill and time, and may represent higher quality of care than ordering a scan or performing a service.”

The researchers suggest that Medicare should conduct its own study to determine “whether outcomes differ between low and high spenders.”

What patients can do

In the meantime, all of us — whether we’re on Medicare or not — need to educate ourselves about medical tests and procedures to have more informed conversations with our doctors.

A good place to start is with the “Choosing Wisely” campaign, an initiative by the American Board of Internal Medicine Foundation and Consumer Reports magazine “to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources in the United States.” It provides evidence-based lists of tests and procedures that patients should raise questions about with their doctor to ensure that those services, if ordered, are absolutely necessary.

You’ll find those lists on the ABIM website. You’ll find the JAMA Internal Medicine study on that journal’s website, although it’s behind a paywall.

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