Multi-hospital physicians can lower patient expenses, study finds

Welcome to Pocket Science: a glimpse at recent research from Husker scientists and engineers. For those who want to quickly learn the “What,” “So what” and “Now what” of Husker research.

What?

As of 2019, health care spending in the United States had surpassed $3.8 trillion annually — almost 18% of the country’s gross domestic product. In U.S. hospitals, roughly 30% of spending goes to so-called ancillary costs: lab-based diagnostics, radiology-based imaging procedures, and pharmaceuticals, in particular.

Attending physicians oversee a substantial percentage of that spending, given their decision-making authority when it comes to ordering tests, selecting diagnostics and prescribing prescription drugs.

So what?

Nebraska’s Yingchao Lan and colleagues wondered whether ancillary costs might be tied to certain physician- and hospital-related factors. So the researchers accumulated data on more than 163,000 patients treated by 4,400-plus physicians at Florida hospitals between 2014 and 2016.

Their analysis found that patients being treated by physicians who practiced at more than one hospital were charged about 59% less for lab tests and 30% less for radiology — saving an average of $6,704 and $1,881 per hospital visit, respectively. Those lower expenses stemmed from the fact that multi-site physicians generally ordered fewer tests and procedures. Despite that, the researchers uncovered no meaningful difference in the mortality rates of patients treated by multi-site vs. single-site physicians.

Based on prior research, the team proposed that multi-site physicians pick up best practices across hospitals and better collaborate with colleagues to identify when certain tests would prove redundant or unnecessary. That dovetails with an emerging, “value-based” approach to health care now being incorporated into the curricula of some medical schools.

Accordingly, the team also found that multi-site physicians with less experience actually saved their patients more money. Patients treated by multi-site physicians in the 25th percentile of experience saved $9,348 on radiology, compared with just $2,967 when physicians were in the 75th percentile.

Now what?

Multi-hospital systems might deliver more economical treatment by rotating physicians among sites and offering advanced training in value-based management, the researchers said.