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How do physicians view proposed policies to cut costs in health care?

Study finds that U.S. physicians accept some responsibility for reducing costs but patient’s best interests override expense; mixed views on payment changes

ANN ARBOR, Mich. — Most U.S. physicians feel a responsibility to help make healthcare leaner by containing health costs but many are less enthusiastic about cost-reducing strategies that involve changes in payment models, according to a new study from the Mayo Clinic and University of Michigan.

Researchers surveyed nearly 2,500 U. S. physicians to gain insight on caregiver attitudes about health care costs just as the country faces major policy reforms in healthcare. Results appear in the Journal of the American Medical Association (JAMA). 

“Physicians clearly struggle with considering resource constraints and their patients' interests,” says senior author Susan Dorr Goold, M.D., M.H.S.A., M.A., professor of Internal Medicine and Health Management and Policy at the U-M Medical School and School of Public Health and newly elected chair of the American Medical Association Council on Ethical and Judicial Affairs.

“Professional organizations, including the AMA and the ACP (American College of Physicians), have recently provided guidance on how physicians can practice good stewardship while maintaining their role as patient advocates.”

Jon C. Tilburt, M.D., M.P.H., of the Mayo Clinic, Rochester, Minn., was lead author of the study.

Physicians were asked about their views on 17 specific strategies to reduce health care spending, including proposed policies in the Patient Protection and Affordable Care Act. They were also surveyed on their perceived roles and responsibilities in addressing health care costs as care providers.

The vast majority of U.S. physicians (85 percent) agreed that trying to contain costs was a responsibility of every physician but most respondents prioritized patients’ best interests over cost concerns. 

Most surveyed physicians supported cost-containment initiatives aimed at improving the quality and efficiency of care, such as promoting chronic disease care coordination and limiting corporate influence on physician behavior. 

Substantial financing reforms, however, were much less popular among physicians. Examples include bundled payments, penalties for readmissions, eliminating fee-for-service reimbursement and other Medicare pay cuts.

Physicians also believed that patients, pharmaceutical companies, and malpractice lawyers shared as much or more of the responsibility for containing escalating healthcare costs.

Additional authors: Matthew K. Wynia, M.D., M.P.H., Robert D. Sheeler, M.D.; Bjorg Thorsteinsdottir, M.D., Katherine M. James, M.P.H.; Jason S. Egginton, M.P.H.; Mark Liebow, M.D., M.P.H.; Samia Hurst, M.D.,; Marion Danis, M.D., M.P.H.

Disclosures: None

Funding: Greenwall Foundation and the Mayo Clinic Program in Professionalism and Ethics.

Reference: “Views of U.S. Physicians about Controlling Health Care Costs,” JAMA, July 23, 2013, doi: 10.1001/jama.2013.8278.

 

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