Returns to Physician Human Capital:  Analyzing Patients Randomized to Physician Teams

Doyle, Jon; Ewer, Steven M.; Wagner, Todd H.

doi:10.3386/w14174

Cited by 5 publications

(5 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly,Currie et al (2016) find that cardiologists who use invasive procedures for heart attacks more frequently have better outcomes.5 This finding is also consistent withDoyle et al (2010), who find that patients randomly assigned to the physician team from the higher-ranked residency program incurred lower costs and indistinguishable outcomes from those assigned to the team from the lower-ranked program.…”

supporting

confidence: 55%

“…Our paper contributes primarily to two recent literatures. One literature has leveraged the quasi-random assignment of patients to hospitals and physician groups in order to evaluate different aspects of physician practice style and resource use across different healthcare settings (see, e.g., Epstein and Nicholson, 2009;Doyle et al, 2010Doyle et al, , 2014Currie et al, 2016;Currie and MacLeod, 2017). Our study uses similar identifying variation to this literature and has overlapping goals.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments

Gowrisankaran¹,

Joiner²,

Léger³

2017

View full text Add to dashboard Cite

We examine the variation across emergency department (ED) physicians in their resource use and health outcomes, and the relationship between ED resource use and future healthcare costs and outcomes. Our data record the initial treating hospital, ED physician, ED billed expenditures, and all interactions with the provincial health system within the subsequent 90 days for EDs in Montreal, Canada. Physicians in Montreal rotate across shifts between simple and difficult cases, implying a quasi-random assignment of patients to physicians conditional on the choice of ED. We consider three medical conditions that present frequently in the ED and for which mistreatment can result in dramatic consequences: angina, appendicitis, and transient ischemic attacks. To control for variation across physicians in their diagnostic acumen, for each condition, our sample consists of patients with a broader set of symptoms and signs that could be indicative of the condition. We regress measures of healthcare costs on indicators for the hospital and ED physician separately by condition. We then evaluate the correlations between different measures of skill and resource use. We find strong positive correlations of physician resource use and skills across the three conditions. However, physicians with costly practice styles are often associated with worse outcomes, in terms of more ED revisits and more hospitalizations. One exception is that for patients in the angina sample, ED physicians with more spending have fewer hospitalizations. Comparisons of physician effects for the base and broader sets of conditions show that both diagnosis and disposition skills are important.

show abstract

supporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments

Gowrisankaran¹,

Joiner²,

Léger³

2017

View full text Add to dashboard Cite

show abstract

“…The number of procedures is another measure of treatment intensity, while the likelihood of receiving treatment within 1 day could reflect quality in that delays may be associated with treatment by less‐qualified physicians (Doyle, Ewer, and Wagner ), overcrowding, or understaffing. Inpatient mortality is the final outcome measure.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Hospital Mergers on Treatment Intensity and Health Outcomes

Hayford

2011

Health Services Research

View full text Add to dashboard Cite

Objective. To analyze the impact of hospital mergers on treatment intensity and health outcomes. Data. Hospital inpatient data from California for 1990 through 2006, encompassing 40 mergers. Study Design. I used a geographic-based IV approach to determine the effect of a zip code's exposure to a merger. The merged facility's market share represents exposure, instrumented with combined premerge shares. Additional specifications include Herfindahl Index (HHI), instrumented with predicted change in HHI.Results. The primary specification results indicate that merger completion is associated with a 3.7 percent increase in the utilization of bypass surgery and angioplasty and a 1.7 percent increase in inpatient mortality above averages in 2000 for the average zip code. Isolating the competition mechanism mutes the treatment intensity result slightly, but it more than doubles the merger exposure effect on inpatient mortality to a 3.9 percent increase. The competition mechanism is associated with a sizeable increase in number of procedures. Conclusions. Unlike previous studies, this analysis finds that hospital mergers are associated with increased treatment intensity and higher inpatient mortality rates among heart disease patients. Access to additional outcome measures such as 30-day mortality and readmission rates might shed additional light on whether the relationship between these outcomes is causal. Key Words. Hospitals, mergers, quality Consolidation is a common response to financial and competitive pressures in many markets. The primary concern is often financial: will the merger increase prices? The health care sector involves additional complications. For example, both dimensions of demand for health care services are affected by third parties: treatments are prescribed by physicians while health insurance shields consumers from the full costs of care. Prices do not reflect their demand curve but are instead set by the insurer for public

show abstract

“…Even if a particular physician is absent during a month, the characteristics of the physicians on the team in the unit do not vary on a month to month basis because patients are cared for by other members of the physician's team and practice styles within physician groups tend to be homogeneous (Wennberg and Gittlesohn 1973). More recent work by Doyle, Ewer, and Wagner (2010) demonstrated that patient outcomes in the VA were invariant to physician team assignment. 9 Outside of the VA, Medicare pays a fixed amount based on the patient's admitting diagnosis.…”

mentioning

confidence: 99%

Human Capital and Productivity in a Team Environment: Evidence from the Healthcare Sector

Bartel

Beaulieu²,

Phibbs

et al. 2014

American Economic Journal: Applied Economics

110

View full text Add to dashboard Cite

Using panel data from a large hospital system, this paper presents estimates of the productivity effects of human capital in a team production environment. Proxying nurses' general human capital by education and their unit-specific human capital by experience on the nursing unit, we find that greater amounts of both types of human capital significantly improve patient outcomes. Disruptions to team functioning attributable to the departure of experienced nurses, the absorption of new hires, and the inclusion of temporary contract nurses are associated with significant decreases in productivity beyond those attributable to changes in nurses' skill and experience. (JEL I11, J22, J24, M12, M54)

show abstract

Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams

Cited by 5 publications

References 58 publications

Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments

Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments

The Impact of Hospital Mergers on Treatment Intensity and Health Outcomes

Human Capital and Productivity in a Team Environment: Evidence from the Healthcare Sector

Contact Info

Product

Resources

About