Physician Support Mixed for Cost-Containment Strategies

Steven Fox

July 23, 2013

Physicians in the United States assume some responsibility for helping hold down healthcare costs, according to results from a new survey. However, they tend to reject reforms that would change the way they are compensated.

Jon C. Tilburt, MD, MPH, from the Mayo Clinic, Rochester, Minnesota, and colleagues report the results of the survey in the July 24/31 issue of JAMA.

"Given their roles, physicians' perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general are increasingly germane to recent pending and proposed policy reforms," the authors write.

To find out how physicians feel about various reforms, these researchers collected survey data from 2556 physicians randomly chosen from an American Medical Association database.

The survey asked respondents to rate their enthusiasm (not enthused, somewhat enthused, or very enthusiastic) about 17 specific strategies for reducing healthcare costs. The strategies included, but were not limited to, provisions in the Affordable Care Act.

The investigators say more than half the respondents viewed trial lawyers, health insurance companies, hospitals, pharmaceutical/device manufacturers, and patients as all bearing a "major responsibility" for reducing healthcare costs.

However, only 36% believed that practicing physicians had the same level of responsibility.

About three quarters characterized themselves as being "very enthusiastic" about promoting continuity of care. Just more than half expressed the same enthusiasm for expanding access to data on quality and safety, and just more than half supported limiting access to costly treatments that had been shown to have little net benefit.

Only 7% said they were enthusiastic about eliminating fee-for-service payment models. Respondents who expressed that view were also more likely to favor key cost-containment tactics such as salary-plus-bonus or salary-only compensation plans. "Medicare pay cuts are unpopular across the board," the authors report.

On the basis of their findings, these investigators suggest that perhaps the best way to get physician to back cost-cutting strategies would be to start with steps that enjoy widespread support.

"More aggressive (and potentially necessary) financing changes may need to be phased in, with careful monitoring to ensure that they do not infringe on the integrity of individual clinical relationships," they conclude.

In an editorial accompanying the study, coauthors Ezekiel J. Emanuel, MD, PhD, and Andrew Steinmetz, BA, from the University of Pennsylvania, Philadelphia, write, "The findings suggest that physicians do not yet have that 'all-hands-on-deck' mentality this historical moment demands."

They add, "Physicians must commit themselves to act like the captain of the health care ship and take responsibility for leading the United States to a better health care system that provides higher-quality care at lower costs."

This research was funded by the Greenwall Foundation, Mayo Clinic Foundation, and Swiss National Science Foundation. The authors and editorialists have disclosed no relevant financial relationships.

JAMA. 2013;310:34-375, 380-388.

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