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Survey Assesses Physicians’ Views Regarding Controlling Health Care Costs

Few docs want to eliminate fee for service (July 23)

In a survey of approximately 2,500 U. S. physicians on their perceived role in addressing health care costs, they reported having some responsibility to address costs in their practice and expressed general agreement with quality initiatives that may also reduce cost, but expressed less enthusiasm for cost containment involving changes in payment models, according to a report in the July 24/31 issue of JAMA.

Most respondents 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 a “major responsibility.” Most physicians were “very enthusiastic” for “promoting continuity of care” (75%), for “expanding access to quality and safety data” (51%), and for “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs.

Few respondents expressed enthusiasm for “eliminating fee-for-service payment models” (7%).

The authors state: “Most physicians reported being ‘aware of the costs of the tests/treatments [they] recommend’ (76%), agreed that 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 physicians (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 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.” Also, group or government practice settings and having a salary plus bonus compensation type were positively associated with cost-consciousness.

The authors conclude: “In this survey, we found that [U.S. physicians] express considerable enthusiasm for several proposed cost-containment strategies that aim to enhance or promote high-quality care, such as improved continuity of care. However, there is considerably less enthusiasm for more substantial financing reforms, including bundled payments, penalties for readmissions, and eliminating fee-for-service reimbursement; Medicare pay cuts are unpopular across the board.”

Source: JAMA Network; July 23, 2013.

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