The chart above illustrates the annual growth rates of per capital Medicare spending in five metropolitan areas of the U.S. Each area represents a “hospital-referral region,” which is the natural catchment or service area for health care for these five markets. The metros are located in Florida, New York, Massachusetts, California, and Oregon — well spread out to demonstrate the authors’ points.
The researchers found that when presented with strong evidence about clinical interventions, physicians in all regions were equally likely to recommend the same treatments. However, in the fast-cost-growth regions, doctors recommended other services that were in the gray area of clinical evidence (such as admission to an ICU versus recommending palliative care at home).
Health Populi’s Hot Points: Physicians determine the bulk of hospital and prescription drug spending: thus, when trying to address the challenge of managing health cost growth in the U.S., it’s in physician decision making where big impacts can be achieved. However, motivating physicians to behave as if they all operated in Salem, Oregon, can only be accomplished through the right mix of incentives and information. The current reimbursement system rewards on volume, not on quality and certainly not on standardized protocols.
This underscores the importance of getting real-time information into the hands of clinicians at the point-of-care and decision making. Aligning payment with those sound decisions will help stem cost-inflation and, at the same time, ensure better health care quality for patients throughout the nation.