However, costs for the most expensive Medicare patients were 3.5% higher for those with doctors who reported too little time for office visits compared with doctors who reported no time constraints.
“The findings that physicians reporting more severe time pressure have patients who are more costly on average are consistent with the fragmentation results,” the authors write. “Time pressure may be associated with poorer quality, which subsequently results in poorer outcomes and higher costs; or physicians who report time pressure may be more likely to refer to specialists or use technology rather than cognitive skills for diagnosis.”
Research also suggests more frequent use of more profitable services. Researchers estimated the difference between costs and Medicare fees for some services and found “higher relative fees are associated with greater service provision,” the study says.
Funded by the Robert Wood Johnson Foundation, the study used 12 months of Medicare claims that included a sample of 1.6 million beneficiaries. The authors, researchers at the Center for Studying Health System Change, George Mason University, and Social and Scientific Systems, says the changes with the most potential to slow health spending would be those designed to improve care and lower costs for specific types of complex and costly patients.
Authors said the study's findings could be applicable as policy-makers consider payment reform. They also noted efforts under way to study geographic variation in health spending, including the 34-month initiative launched last year by the Institute of Medicine.
“Setting rates applicable to all providers based on average area costs (especially if outcomes are not considered) is likely to punish efficient providers in high-cost areas and reward inefficient providers in low cost areas,” write the researchers, who sought to identify factors that drive spending for the highest-cost Medicare patients.
“At the same time, evidence from physicians' responses to sustainable growth rate fee cuts suggests that across-the-board change in payment updates are an inefficient way to lower costs,” the paper says.
Physician groups have battled against pay cuts under the sustainable growth rate formula and Congress has repeatedly stalled the reductions, including a string of short delays last year that frustrated physicians as lawmakers wrangled over the cost.
One recent projection from the Congressional Budget Office said without the doctor pay cuts, deficits would increase to 6% of the nation's economic output from 3.6% through 2021.