Physicians With The Least Experience Have Higher Cost Profiles Than Do Physicians With The Most Experience
- Ateev Mehrotra ( [email protected] ) is an associate professor of medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, and a policy analyst at the RAND Corporation in Pittsburgh, Pennsylvania.
- Rachel O. Reid is a medical student at the University of Pittsburgh.
- John L. Adams is principal senior statistician at the Kaiser Permanente Center for Effectiveness and Safety Research, in Pasadena, California.
- Mark W. Friedberg is a natural scientist at the RAND Corporation, a practicing general internist, and a clinical instructor at Brigham and Women’s Hospital and Harvard Medical School, in Boston, Massachusetts.
- Elizabeth A. McGlynn is director of the Kaiser Permanente Center for Effectiveness and Safety Research, in Pasadena, California.
- Peter S. Hussey is a policy researcher at the RAND Corporation in Arlington, Virginia.
Health plans and Medicare are using cost profiles to identify which physicians account for more health care spending than others. By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending. To identify which physician types, if any, might be costlier than others, we analyzed cost profiles created from health plan claims for physicians in Massachusetts. We found that physicians with fewer than ten years of experience had 13.2 percent higher overall costs than physicians with forty or more years of experience. We found no association between costs and other physician characteristics, such as having had malpractice claims or disciplinary actions, board certification status, and the size of the group in which the physician practices. Although winners and losers are inevitable in any cost-profiling effort, physicians with less experience are more likely to be negatively affected by policies that use cost profiles, unless they change their practice patterns. For example, these physicians could be excluded from high-value networks or receive lower payments under Medicare’s planned value-based payment program. We cannot fully explain the mechanism by which more-experienced physicians have lower costs, but our results suggest that the more costly practice style of newly trained physicians may be a driver of rising health care costs overall.