UCLA findings suggest that the practice may not be in patients’ best interest.
In results they characterized as “very surprising,” UCLA researchers found for the first time that higher-earning clinicians make more money by ordering more procedures and services per patient rather than by seeing more patients, which may not be in patients’ best interest.
The researchers, from UCLA’s Department of Urology and the Veterans Health Administration, examined the amount Medicare was billed and the amount paid to clinicians. They reviewed data from Medicare Part B payments during 2012.
“Medicare spending is the biggest factor, crowding out investment in all other social priorities,” said Dr. Jonathan Bergman, the research letter’s first author and an assistant professor of urology and family medicine at the David Geffen School of Medicine at UCLA.
“With clinicians making more not by seeing more unique patients, but by providing more services per person, additional research needs to be done to determine if these additional services are contributing to improved quality of care,” Bergman said. “These findings suggest that the current health care reimbursement model — fee-for-service — may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians.”
The research letter was published in the journal JAMA Internal Medicine.
Bergman, who also is a urologist and bioethicist at the VA Greater Los Angeles Healthcare System, believes the review of Medicare data is important because of its potential impact on public policy.
“Our findings suggest a weakness in fee-for-service medicine,” he said. “Perhaps it would make more sense to reimburse clinicians for providing high-quality care, or for treating more patients. There probably shouldn’t be such wide variation in services for patients being treated for the same conditions.”
Further research will need to be done to assess if treatment outcomes differ between those who had more services ordered and those who had fewer. This may also show a clearer view of how to best target resources to maximize value for patients, Bergman said.
Going forward, Bergman and his team will look at alternative payment models, such as those used at Veterans Affairs facilities and in “safety net” hospitals, to see if they make more sense than fee-for-service plans.
The research letter reported: “The goals of payment reform are currently unrealized, as evidenced in these data. Physicians take an oath to care for patients using ‘appropriate means and appropriate ends,’ focusing on what is best for the patient, and this centuries-old oath still resonates with graduates of medical school classes. Rather than react to externalities imposed by payers, clinicians can lead the movement toward a high-value, patient-centered care. We are uniquely empowered to ensure that all individuals access the procedures they need, and are not exposed to those they don’t.”