Oct 31, 2018
As previously discussed, we at Lumere recently surveyed physicians to shed light on the relationship between health system-physician relationships and physician behavior in regard to value-based care. We’ll be publishing the complete results in Physician Leadership Journal early next year, but I’d like to share some preliminary results highlighting the importance of sharing cost data alongside clinical evidence.
First, a note on the methodology: the 19-question survey included 276 physicians from specialties that utilize medical devices and inpatient drug treatment, drawn from SERMO’s database of US physicians. After answering a set of demographic questions, respondents were directed to answer questions for either surgical specialists or medical specialists. The study also considered three hospital delivery alignment models: employed physicians, independent physicians and pay-for-performance models (accountable care organizations, bundled payment, and co-management). Statistical analysis was performed by SERMO.
Alignment Models The survey results demonstrate that employed physicians are not inherently more likely to make device selection decisions that are financially beneficial to their health system. For example, employed and independent surgical specialists reported equally that device cost was “very” or“extremely” influential to these decisions. Additionally, the results suggest that physicians, independent of the alignment models studied, are more likely to be influenced by device cost when they share in device management savings than when the hospital alone realizes the savings.
Access to Cost Data and Evidence Ninety-one percent of survey respondents told us that gaining greater access to cost data would lead to improved quality of care, but only 40% of respondents said their systems were taking active steps to do so. In practice, this is more nuanced. Our analysis shows a direct correlation between physician experience with managing financial performance and the influence of cost data, regardless of whether the patient, the physician’s practice or the health system is responsible for the cost.
Additionally, when we looked at the relationship between the level of physician experience with managing provider costs and cost data, we saw that veteran doctors generally found cost data more influential than less experienced physicians, regardless of alignment type.
Along with cost data, we found physicians are increasingly likely to incorporate clinical evidence and peer-reviewed literature into their drug and device selection process—54% of respondents labeled it as “extremely” or “very important.” Furthermore, 56% believe that physicians should be involved in creating evidence-based clinical protocols, practice guidelines and best practices at their organizations.
Variation While reducing clinical variation is frequently considered an effective method for reducing costs and improving care quality, it is not a widely implemented strategy in many organizations. While the vast majority (86%) of respondents believe that increasing physician access to clinical practice variation data would have a positive effect on care quality, ironically, only 56% said their hospitals/health systems are actively working to reduce practice pattern variation.
These preliminary results from Lumere’s Physician Perceptions and Practices Survey suggest that simply employing physicians is not an effective strategy for driving greater value when considering drug and device costs, utilization and clinical variation. I look forward to sharing the final report with you and continuing this important conversation. If you’d like to be notified when the final results are published, just drop me a quick email at firstname.lastname@example.org and my team will make sure you’re included on the distribution list.
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