The Role of the Physician in Utilization Variance

Utilization of care, and consequently health spending, can vary widely across the United States, and even within small geographic areas.  A large body of research seeks to understand what accounts for these differences in utilization, even after adjustment for differing patient characteristics.  Physician practice patterns or preferences about treatment may be partly responsible.  This study examined variation in admission at the individual hospital level.  It looked at differences in admission rates among emergency room physicians.  The Medicare population was the basis for the study and a very large number of ER visits and admissions were included. The study adjusted for patient health and other factors and still found a roughly 15% variation in likelihood of admission across all physicians.  While not identifying why some physicians appear to admit more or less often than others, this level of variation deserves further exploration, especially in regard to ultimate patient outcomes.  It could be that some physicians are not admitting patients who may need hospital care, although it is more likely that patients are admitted who probably would be fine with further outpatient and home care.  Hospitalizations are very expensive so avoiding unnecessary ones has been a prime cost control tactic.   (HA Article)