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The Origin of Physician Practice Patterns

By August 24, 2016Commentary

Everyone in health care is interested in why physicians practice the way they do.  Payers like Medicare have spent billions trying to encourage or penalize certain practice patterns.  Drug and medical device manufacturers have spent billions to get doctors to use their products.  Everybody has guidelines.  Research published at the National Bureau of Economic Research explores why physicians may develop certain treatment patterns.   (NBER Paper)   This particular paper focuses on adoption of new technology, a well trod path in general marketing research regarding the diffusion of innovation, but the lessons may apply to general development of practice patterns.  The authors examined specifically whether new cancer drugs were adopted more quickly in geographic areas where one of the drug’s pivotal clinical trial authors practiced.  They also stratified these authors by their role in the clinical trial and by past research publication history.  Medicare claims were used to identify use and adoption of 22 new cancer drugs from 1998 to 2008.  Patients in the geographic area where the lead author practices are 36% more likely to receive the drug in the first two years after approval.  This higher rate of use is found both within the lead author’s actual practice group and in other groups in the area.  In contrast, other study authors have an impact and create higher use, but only within their own practice group.  Other measures of being a “high-profile” physician, such as publications, are also associated with higher early adoption rates.  These effects fade over time, so that within four years, there is no difference in use rates of the new drug.  This suggests that the effect is on the speed of adoption, not the ultimate use rate.  Other findings include the highest impact of a lead author is in a region which generally has a low adoption rate of new drugs and that patients appear to travel for treatment to the area where the lead author practices.

It may be that in response to cost concerns, physicians ability to influence the purchase of health care goods–drugs, medical devices and medical equipment–innovative or established, is waning.  PBMs and payers have tightened up drug formularies, limiting doctor flexibility.  Hospitals and health systems no longer treat many implantable devices as “physician preference” items and instead are cutting deals with specific manufacturers that mandate use of a particular product in the facility.  To some extent, even patients have access to more information on products, and can play a role in deciding which product they use.  But the research has great value in helping us understand the more generalizable issue of what leads physicians to adopt a particular practice style.  Medical schools obviously can play a role, but as this study points out, physician “leaders” and peer pressure in the geographic area or specialty of the doctor are also likely very influential.  How this influence actually occurs is unclear.  Does the physician proactively encourage his or her peers to adopt the drug?  Is there just a more general awareness because of publicity or other information spreading about the doctor’s role in the trial?  Do physicians actively track the research activities of other physicians in the area in their specialty, or just track the activities of higher profile physicians?  Is there a role that patients play, particularly in cancer where patients have a heightened awareness of and search behavior for new treatments?  All fascinating questions for more research.

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