Physician Impact on the Total Cost of Care

Taheri, Paul A.; Butz, David A.; Griffes, Louisa C.; Morlock, David R.; Greenfield, Lazar J.

doi:10.1097/00000658-200003000-00017

Cited by 69 publications

(42 citation statements)

References 7 publications

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“…15 Although discretionary costs are a minority of total costs generated in hospitals, 9,[23][24][25][26] ICU care is so expensive 27 that the discretionary component is substantial. 9 Reducing medical costs requires understanding the details of their genesis and in particular the sources of variation. Like other aspects of medical practice, medical costs are subject to large variations not readily explained by characteristics of patients or illnesses.…”

Section: Discussionmentioning

confidence: 99%

“…By admitting patients to hospitals, ordering tests and therapies, and prescribing drugs, physicians strongly influence the variable component of costs. 9 But analyzing the contribution of individual physicians' practice styles to health care costs is confounded by collaborative care, that is, by the fact that multiple physicians commonly contribute to the care of individual patients. Although a few investigators have assessed aspects of this phenomenon, [10][11][12][13] none have directly analyzed how collaborative care by individual physicians influences costs.…”

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confidence: 99%

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Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Garland

2013

American Journal of Critical Care

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Background Improving the cost-effectiveness of health care requires an understanding of the genesis of health care costs and in particular the sources of cost variation. Little is known about how multiple physicians, caring collaboratively for patients, contribute to costs. Objective To explore the effect of collaborative care by physicians on variation in discretionary costs in an intensive care unit (ICU) by determining the contributions of the attending intensivists and ICU fellows. Methods Prospective, observational study using a multivariable model of median discretionary costs for the first day in the ICU, adjusting for confounding variables. Analysis included 3514 patients who spent more than 2 hours in the ICU on the initial day. Impact of the physicians was assessed via variables representing the specific intensivist and ICU fellow responsible on the first ICU day and allowing for interaction terms. Results On the initial day, patients spent a median of 10.6 hours (interquartile range, 6.3-16.5) in the ICU, with median discretionary costs of $1343 (interquartile range, $788-2208). There was large variation in adjusted costs attributable to both the intensivists ($359; 95% CI, $244-$474) and the fellows ($756; 95% CI, $550-$965). The interaction terms were not significant (P = .12-.79). ConclusionsIn an ICU care model with intensivists and subspecialty fellows, both types of physicians contributed significantly to the observed variation in discretionary costs. However, even in the presence of a hierarchical arrangement of clinical responsibilities, the influences on costs of the 2 types of physicians were independent.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Garland

2013

American Journal of Critical Care

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“…Intuitively, it is thought that reducing the LOS decreases cost. 49 However, many variables must be taken into consideration for this belief to become reality. Many studies have shown that patients incur more expenses early in their hospitalization, especially the first 2 days, than at the end of their stay.…”

Section: Targeting Losmentioning

confidence: 99%

“…Many studies have shown that patients incur more expenses early in their hospitalization, especially the first 2 days, than at the end of their stay. 49 In surgical specialties, the notion that not all hospital days are economically equivalent is even more valid. The financial impact of a decreased LOS varies depending on the overall length of the hospitalization.…”

Section: Targeting Losmentioning

confidence: 99%

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

McLaughlin¹,

Upadhyaya²,

Buxey³

et al. 2014

JNS

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H ealtH care expenditures in the US continue to rise annually, faster than the national income. In 2010, health spending exceeded 17% of the nation's gross domestic product. 23,29 Numerous elements of national health reform are aimed at cost containment. Importantly, "bending the cost curve" refers most commonly to the government or insurers' payment to providers. However, reducing reimbursements does not decrease the cost of care delivery. The critical issue is how to deliver improved outcomes at the lowest cost and achieve the highest value of care. 41 Although health care providers have put significant effort into the quality and safety of care delivered in the past decade, little attention has been focused on cost measurement and even less on cost containment. This oversight stems from the fact that health systems, departments, and individual physicians misunderstand the costs related to the care they deliver.Early in 2009, the Department of Neurosurgery at our institution, aiming to improve the delivery of neurosurgical care, launched a Clinical Quality Program.2 Numerous improvement processes aimed at optimizing preoperative, intraoperative, and postoperative patient care were implemented by the third quarter of 2009. Previously, we assessed whether the multidisciplinary and multifaceted efforts instituted in 2009 succeeded in improving our delivery of value-based neurosurgery. 2,32 For that initial case study, patients undergoing microvascular decompression (MVD) performed by one neurosurgeon (N.A.M.) was the proposed model given that the surgical technique was standard, anticipated operative risks were relatively predictable, and perioperative care was relatively similar between cases. We documented a favorable impact from Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaObject. Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives.Methods. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all...

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“…The best cost reductions in a 1-year survey were achieved in pharmacy (57%), nursing (24%), and emergency (36%) [41]. Other estimates of a hospital overhead of 84% [14] have been found to be way beyond the physician's immediate control [42]. It is of utmost importance that the high fixed costs of a hospital are unaffected by differing patient numbers.…”

Section: Cost Calculations On the Basis Of A Trauma Registrymentioning

confidence: 99%

Documentation of Blunt Trauma in Europe Survey of the Current Status of Documentation and Appraisal of the Value of Standardization

et al. 2000

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During the last decade, several European communities have begun to perform multicenter approaches to document trauma care and trauma care outcome. So far every country has begun to do this without communicating with each other and no coordination has been performed. The current manuscript compares these modes of documentation, their advantages and evaluates options for future standardization. Even though to date a wide variety of structures is available, the value and the opportunities of a European-wide standardized documentation process is highlighted.

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Physician Impact on the Total Cost of Care

Cited by 69 publications

References 7 publications

Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Effect of Collaborative Care on Cost Variation in an Intensive Care Unit

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

Documentation of Blunt Trauma in Europe Survey of the Current Status of Documentation and Appraisal of the Value of Standardization

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