Three recently published studies demonstrated how physician compensation and workload can affect healthcare quality.
A study in the Archives of Internal Medicine found that heavier workloads for hospital residents and their supervisors can lead to increased lengths of stay for patients, greater costs and higher risks of death.
The authors analyzed data on 5,742 adults admitted to the general medicine service of the University of California at San Francisco’s Moffitt-Long Hospital between July 1998 and June 2001.Each additional admission for a team of caregivers led to higher costs and additional risks for all the team’s patients, according to the study.
Risks increased substantially when a team admitted more than nine patients. At the same time, a "higher average team census was associated with reduced resource use, perhaps reflecting service-level adaptations to workload," according to the report.
Michael Ong, M.D., a researcher at the University of California at Los Angeles, says hospitals and resident-training programs must find ways to respond to higher workloads, including using discharge planners and improving oversight of teams with high workloads.Meanwhile, a study by the Washington-based Center for Studying Health System Change says more doctors than ever before are being paid on the basis of quality of care, but salaries for the vast majority of America’s physicians remain tied to productivity in a reimbursement system founded on fee-for-service.
The survey indicated that financial incentives were tied to quality indicators for 20.2% of doctors in group practices in 2004-05, a small but "statistically significant" increase from the proportion of 17.6% in 2000-2001. But since 1996-97, according to the national policy research group, salaries for about 70% of doctors who weren’t in solo practices were tied to individual productivity. The surveys looked at 12-month periods.
The heavy emphasis on productivity measures "likely increases the cost of care by encouraging the provision of more services to patients," says Paul Ginsburg, president of the organization. The statistics, part of the organization’s nationally representative community tracking study of physicians, are based on surveys from about 12,000 doctors in the earlier studies and approximately 6,600 in the 2004-05 report. The survey also found that about one out of every four physicians not in solo practices do not have compensation tied to any explicit financial incentive.
And a study published online by the Annals of Emergency Medicine found that almost half of Oregon emergency rooms can’t offer around-the-clock on-call coverage in at least one specialty, and about 13% of the state’s hospitals have had their trauma designations downgraded because of on-call deficiencies.The lack of on-call coverage persisted despite offers of substantial stipends to specialists. "Shortages of specialists willing to take call in the emergency department are a nationwide problem and represent a major change in the way we provide emergency care," says lead author K. John McConnell, a researcher at Oregon Health & Science University. The survey, conducted in the summer of 2005, found shortages in most specialties, with the most-severe shortages in orthopedics and neurosurgery coverage.
Researchers say several factors contribute to specialists’ reluctance to take call, including inadequate reimbursement, the threat of lawsuits and the growth of ambulatory surgery centers and specialty hospitals.