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Doctors choose patients over cost saving

Survey finds cost-containment initiatives that improve quality and efficiency are supported, but docs are mixed on bundled payment

While most physicians feel some degree of responsibility to address healthcare costs, they will side with patient need over expense, a Mayo Clinic-led survey of 25,000 U.S.-based physicians has found.

"Physicians feel stuck in a difficult position," said lead author Jon Tilburt, MD, of Mayo Clinic's Biomedical Ethics Program and Center for the Science of Health Care Delivery, in a prepared statement. "Despite their sense of responsibility to address healthcare costs, physicians consistently express a commitment to the best interests of patients even when it is expensive. Given this finding, we recommend that cost-containment strategies aimed at physician behavior should focus on innovations that not only promote savings but also preserve physicians' commitment to individual patients."

[See also: Docs need training in cost awareness]

The survey's key findings include:

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All information courtesy of the Mayo Clinic. Presentation by PhysBizTech.com.

  • Most expressed enthusiasm for cost-containment initiatives aimed at improving the quality and efficiency of care, and favored improving conditions for making decisions based upon cumulative medical evidence. For example, 69 percent were very enthusiastic about promoting chronic disease care coordination, and 63 percent were very enthusiastic about limiting corporate influence on physician behavior.
  • Physicians' opinions were mixed on making payment changes to control costs. For example, 65 percent were not enthusiastic about paying a network of practices a fixed, bundled payment for managing all care for a defined population, and 70 percent were not enthusiastic about eliminating fee-for-service payment models.

"We found that physicians' degree of enthusiasm for various cost-containment strategies was associated with practice setting and compensation structure," concluded Tilburt. "Salaried physicians and those in larger institutional practice settings reported a significantly higher degree of cost-consciousness compared to physicians whose compensation is based on billing and those in small or solo practices."

Funded by the the Greenwall Foundation and the Mayo Clinic Program in Professionalism and Ethics, the survey was published in the Journal of the American Medical Association (JAMA).