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Doctors tepid about cost containment

They realize they have a role in containing costs but not through payment changes

Doctors acknowledge they have a role in helping to contain healthcare costs but they lack enthusiasm for cost containment achieved through changes in payment models.

A recent survey published in the Journal of the American Medical Association provides a look at physicians’ views on several potential proposed policies and strategies to contain healthcare spending and assessed physicians' perceived roles and responsibilities in addressing healthcare costs.

[See also: Doctors choose patients over cost saving]

Jon C. Tilburt, MD, MPH, of the Mayo Clinic, Rochester, Minn., and colleagues mailed the survey in 2012 to 3,897 U.S. physicians randomly selected from the American Medical Association master file. A total of 2,556 physicians responded (65 percent response rate). The survey asked respondents to rate their level of enthusiasm (not, somewhat or very enthusiastic) toward 17 specific means of reducing healthcare costs, including but not limited to strategies proposed in the Affordable Care Act; and agreement with an 11-measure cost-consciousness scale.

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Among the findings:

  • Most respondents believed that trial lawyers (60 percent), health insurance companies (59 percent), hospitals and health systems (56 percent), pharmaceutical and device manufacturers (56 percent) and patients (52 percent) have a “major responsibility” for reducing healthcare costs, but only 36 percent reported that practicing physicians have “major responsibility.”
  • Most physicians were “very enthusiastic” for “promoting continuity of care” (75 percent); “expanding access to quality and safety data” (51 percent); and “limiting access to expensive treatments with little net benefit” (51 percent) as means of reducing healthcare costs.
  • 7 percent called for eliminating fee-for-service payment models.
  • 76 percent reported being aware of the costs of the tests/treatments they recommend.
  • 79 percent agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care; 78 percent agreed that they should be solely devoted to individual patients' best interests, even if that is expensive; and 89 percent felt that they need to take a more prominent role in limiting use of unnecessary tests.
  • 85 percent 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 setting and having a salary plus bonus compensation type were positively associated with cost-consciousness.

“U.S. physicians' opinions about their role in containing healthcare costs are complex,” the researchers wrote in their report. Moving them toward more cost-conscious care will require strategies for which there is physician support, they concluded. Furthermore, they wrote, “more aggressive (and potentially necessary) financing changes may need to be phased in, with careful monitoring to ensure that they do not infringe on the integrity of individual clinical relationships.”

In an accompanying editorial titled "Will Physicians Lead on Controlling Health Care Costs?" Ezekiel J. Emanuel, MD, PhD, and Andrew Steinmetz of the University of Pennsylvania, wrote that the findings of this survey “are somewhat discouraging.”

“The findings suggest that physicians do not yet have that ‘all-hands-on-deck’ mentality this historical moment demands. Indeed, the survey … suggests that in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious instinctual approaches humans adopt whenever confronted by uncertainty: blame others and persevere with ‘business as usual.’”

“The study by Tilburt et al indicates that the medical profession is not there yet — that many physicians would prefer to sit on the sidelines while other actors in the healthcare system do the real work of reform. This could marginalize and demote physicians. Physicians must commit themselves to act like the captain of the healthcare ship and take responsibility for leading the United States to a better healthcare system that provides higher-quality care at lower costs.”

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