Doctors practicing in the U.S. are becoming increasingly conscious of the increasing costs of health care. Most consider themselves cost-conscious, and are considering the impact of their practice patterns — in terms of prescribing medicines, tests, and procedures — on the nation’s health bill. In fact, most physicians feel they have a responsibility to bring down health costs.

This perspective on physicians comes from the survey report, The new cost-conscious doctor: Changing America’s healthcare landscape, from Bain & Company, published in March 2011. Bain spoke with over 300 U.S. physicians to assess their perspectives on managing costs, drug and device usage, and standardized care protocols.

The top-line finding is that, regardless of physician demographic — whether male or female, salaried or productivity-based, specialist or generalized, urban or rural, young or mature, doctors uniformly see that they must change clinical practice patterns to accommodate the realities of health economics.

The impacts of this on the practice will be many, including:

  • Consolidating practices, increasingly being absorbed into hospital systems
  • Decreasing utilization as a direct response to incentives
  • Promoting preventive care
  • Adapting to standardized treatment protocols.

Health Populi’s Hot Points:   Bain rightly points out that these changed physician attitudes and behaviors will ripple through the health supply chain on to life science, medical device, pharmaceutical and technology companies. Organizations in these health supply segments must demonstrate value to physicians and patients in the larger health ecosystem in order to be adopted into clinical practice.

That physicians see cost management as part of their jobs now means that their decisions will be increasingly impacted by their collective cost consciousness lens. Accountable care models, medical homes and more tightly integrated delivery networks will bolster this approach and tightly focus that cost conscious lens. Physicians will be less inclined to try out new-new products without firm proof-of-concept and references from peer physicians who are influencers in their field. Over one-half of physicians told Bain that they’d be using comparative effectiveness analyses within 2 years.

Furthermore, physicians are growing more comfortable with practice protocols and standardized care, Bain found. They’re using clinical guidelines more often in 2011 than 5 years ago; this is especially true of younger physicians, who more often refer to practice guidelines for patients. The mass adoption and full implementation of electronic health records will enable such protocols to be pushed to clinicians at the point-of-care. In fact, physicians expect a five-fold increase in the prevalence of electronic access to clinical treatment guidelines, and an 8-fold increase in pay-for-performance programs.

For manufacturers in the health supply chain, the major challenge is to develop and market products that help lower the costs of health care. That’s the new definition of “innovation” in health care.

4 Comments on Physicians in the U.S. are becoming health economists

Mark Spohr said : Guest Report 12 years ago

Mammograms are a particularly bad example of cutting costs since many studies have demonstrated that they lead to over-diagnosis and over-treatment and end up increasing morbidity and mortality. If doctors are really interested in cutting costs they would stop ordering unnecessary tests and procedures but this is difficult when they benefit directly from these activities. Do you really need an MRI or CT scan for a sprained ankle? If you doctor has a financial interest in an imaging center, then surely you do need these tests.

Irene said : Guest Report 12 years ago

Interesting read. Perhaps the pendulum is beginning to swing in this direction; however, I agree with the previous poster. Perhaps on the front end of the medical "transaction", they appear to be more conscientious, but on the back end? Not so much. At least 60% of the medical bills I check for my clients are incorrectly coded and billed; sadly, still so many dr's double-dip.

Tammy said : Guest Report 12 years ago

I suspect this cost-consciousness will lead to gaps in patient care in order to save money. Funny things show up on this year's mammogram? "Well, you're young so we'll hold off on getting the obligatory ultrasound till after your mammogram next year," even though those things we saw might be tumors. Or, "Since you had an ultrasound last year after your mammogram, will skip ordering one now," even if that means we can't explain the weird stuff on this year's mammogram. Bottom line: "You have a cancer that we could have caught early with additional tests, but look at all the money we saved the insurance company by not ordering them!"

Mark Spohr said : Guest Report 12 years ago

This is surprising to me. Have you ever tried to find out from a doctor what a visit, procedure or test will cost? I have and they don't have a clue. The may refer you to a billing clerk who either won't have a clue or will give you wrong (usually lowball) information or tell you that it's covered by insurance so don't worry about it (often it's not and you should worry about it). Doctors may have some vague concept of a threat in a cloud over their Porsche that they should be worrying about how much they are costing patients but this hasn't translated into anything useful.

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