Of special concern to both public and private insurers are physicians whose practice patterns account for more health care spending than that of other physicians. With Commonwealth Fund support, researchers analyzed the cost profiles of physicians in Massachusetts to ascertain whether some physician types are more costly than others.
What the Study Found
The authors created individual physician cost profiles using insurance claims from 1.13 million patients ages 18 to 65 who were continuously enrolled in one of four commercial health plans in Massachusetts in 2004–05. Doctors with fewer than 10 years of experience had 13.2 percent higher overall costs than those with 40 or more years of experience. There was no association between costs and other physician characteristics, such as malpractice claims filed or disciplinary actions taken, board certification status, or size of practice or medical group.
Physicians with less experience are more likely to be penalized under policies that use cost profiles in an attempt to reduce health care spending. For example, doctors with higher cost profiles might be excluded from high-value networks, or they might receive lower payments under Medicare's value-based purchasing program. The authors say their findings suggest that "that the more costly practice style of newly trained physicians may be a driver of rising health care costs overall."