Variation in Physician Spending and Association With Patient Outcomes.

摘要: Importance While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians. However, degree to which varies physicians consequences of that unknown. Objective To investigate its association with patient outcomes. Design, Setting, Participants For this retrospective data analysis, we analyzed a 20% random sample Medicare fee-for-service beneficiaries 65 years older who were hospitalized nonelective medical condition treated general internist between January 1, 2011, December 31, 2014. We first quantified proportion Part B attributable hospitals, physicians, patients. then examined physician outcomes, adjusted for characteristics hospital fixed effects (effectively comparing within same hospital). Our primary analysis focused on hospitalist whose patients plausibly quasirandomized based work schedule. A secondary internists overall. ensure illness severity did not directly affect estimates, calculated physicians’ levels 2011 through 2012 outcomes their 2013 Exposures Physicians’ level 2012. Main Outcomes Measures Patients’ 30-day mortality readmission rates Results determine amount included 485 016 hospitalizations 21 963 at 2837 acute hospitalists 839 512 50 079 3195 internists. Variation was larger than (for hospitalists, 8.4% vs 7.0% hospitals; internists, 10.5% 6.2% hospitals). Higher associated lower (adjusted odds ratio [aOR] additional $100 spending, 1.00; 95% CI, 0.98-1.01; P  = .47) or readmissions (aOR, 0.99-1.01;  = .54) hospital. observed similar patterns among Conclusions Relevance Health more individual hospitals. higher better findings suggest policies targeting both may be effective reducing wasteful focusing solely