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Physician Practice Patterns

By April 13, 2023Commentary

An enduring mystery in health care is why different physicians appear to treat the same patient with different patterns of care.  Because these differences in approach might result in some higher costs and some lower quality, for decades research has attempted to identify the “best” practice patterns and why doctors have variable ones and how they can be encouraged to use the “best” ones.  This is how “evidence-based medicine” arose and why there is a focus now on “value-based purchasing”.  Because I am a dour cynic, I seriously doubt any of it will make any difference, but it gives researchers lots to think about.

This study looked at practice patterns in primary care physicians for Medicare patients.  They used doctor relocations or retirements to identify the impact of a changed practice style on patient outcomes.  As you might expect they find that primary care physicians, who control the referral pen, have substantial impacts on overall utilization and costs for a patient.  But there are also differences in quality of care, as different physicians have different levels of compliance with recommended care guidelines.  For patients who switched to doctors who were delivering more of what was judged to be high-quality care, their rates of ER usage and avoidable hospitalizations declined.  Another intriguing finding is that patients who switch to another physician in the same practice see less change than those who switch to a new practice, suggesting that physicians who practice together tend to have clumped practice patterns.  There was an unclear correlation of spending and quality, with some suggestion that higher quality practice patterns were associated with more physican office spending, but lower overall costs.   (JHE Study)

Join the discussion 3 Comments

  • Roberto says:

    It’s become very clear to me recently that a huge determinant in life expectancy is whether or not an old person has a very concerned advocate who wants to spend their life monitoring the oldster’s health. My mother-in-law had one foot in the grave a few weeks ago until her daughter just stopped all of the ~8 different drugs she was on. It was like she discovered the Fountain of Youth over the next few days and now she seems like she could last another 5-10 years! All those drugs were prescribed by different doctors with no real understanding of how they might interact.

    • Kevin Roche says:

      this hits exactly on a huge problem in geriatric care–excessive use of prescription drugs for elderly patients with doctors who don’t know what they are doing

  • John Oh says:

    Thanks for the summary. I’m not going to bother reading the article. It strikes me that there are just too many variables at work to get to a meaningful conclusion. I also wonder if there’s not an element of self-fulfilling prophecy in using statistics to define best practice, then trying to get everyone to follow best practice. Maybe I’m being simplistic.

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