Views of US Physicians About Controlling Health Care Costs

Abstract

Importance Physicians' views about health care costs are germane to pending policy reforms. Objective To assess physicians' attitudes toward and perceived role in addressing health care costs. Design, Setting, and Participants A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Main Outcomes and Measures Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. Results A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients' best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = -1.95; 95% CI, -2.71 to -1.18; P < .001). Conclusion and Relevance In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

“…[1][2][3][4][5]30 Despite the current nationwide effort to improve value in health care, viewpoints of frontline practicing clinicians on how to achieve better health and decreased costs remain largely unknown. 31 Most physicians agree that they should take a greater role in reducing unnecessary tests, 32 but little is known about the extent to which the typical emergency physician (EP) believes unnecessary diagnostic testing occurs in his or her practice setting or what solutions, if any, she or he feels would help mitigate this practice. Such information is crucial to achieving high-value care and may be especially helpful in light of the upcoming 2015 Academic Emergency Medicine (AEM) consensus conference on diagnostic imaging.…”

Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care

“…Previous research has clearly demonstrated that physicians' perceive a tension between their responsibility to practice cost-consciously and their ability to serve their patients' best interests, 13,[17][18][19] which often manifests in a desire to fulfill their patients' expectations. 5,[14][15][16] Our data suggest that physicians do consider resources in the daily care of patients, but some may be more adept at balancing this tension than others.…”

“…For example, in a recent survey, 85 % of physicians agreed that "trying to contain cost is the responsibility of every physician;" however, more than three-quarters also agreed they "should be solely devoted to their individual patients' best interests, even if that is expensive." 13 Cost-conscious practice is particularly challenging when physicians are faced with patient expectations or request for medical services that may be unnecessary. Previous studies have demonstrated that patient requests influence physician behavior, even after controlling for predisposing factors and the underlying necessity of the request.…”

Capsule Commentary on Tartaglia et al., Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis

“…Despite the fact that this was a small, single-institution sample of medical students near the beginning of their clinical training, students were able to identify many common practices, echoed by residents [ 2 ] and attendings [ 3 ], that were not consistent with the practice of high-value care. However, the possibility for availability bias is pronounced, as the themes outlined by students closely mirrored those taught in the required online module.…”