Who is responsible for out-of-control healthcare costs and who needs to step up to the plate to fix them? That's the gist of a recent survey of almost 4000 US physicians, of whom 2556 responded, with the results published in the Journal of the American Medical Association. Their responses are both informative and interesting, Rick and I agree on PodMed this week, and the authors hope that the results will help policy makers and healthcare reform types understand where doctors are coming from when new initiatives are undertaken.
Regarding who has 'major responsibility' for controlling healthcare costs, 60% of physicians said trial lawyers, followed closely by health insurance companies at 59%, hospitals and health systems at 56%, along with pharmaceutical and device manufacturers at the same percentage, and finally to round out the greater than 50% responsibility group, patients themselves at 52%. Most interestingly, only 36% of responding physicians fingered physicians themselves as having major responsibility for controlling healthcare costs, a fact Rick and I both found fascinating. I contrast this in the podcast with a recent Johns Hopkins study showing that when physicians are apprised of the true cost of tests they order, they voluntarily order fewer of them or seek less expensive alternatives: http://www.hopkinsmedicine.org/news/media/releases/comparison_shopping_by_doctors_saves_money
"Promoting continuity of care," was rated very enthusiastically by the majority of physicians queried (75%) as one means of reducing costs. Both expanding access to quality and safety data as well as limiting access to expensive treatments with little net benefit were also enthusiastically embraced by greater than 50% of respondents.
Are physicians aware of the cost of tests and procedures they order? Just over three-quarters of respondents said they are, with almost 80% saying that physicians should adhere to clinical practice guidelines when deciding which tests or procedures to order. Rick is gratified to note that 78% embraced the notion that they should act first with the patient's best interest at heart, even if that proved expensive. Yet almost 90% said physicians need to take a more prominent role in limiting the use of unnecessary tests! Seems a bit contrary to me, but there it is.
Should we change how physicians get paid in order to get ahead of costs? That notion was extremely unpopular, with only 7% expressing enthusiasm for eliminating fee for service payments. Respondents were also not supportive of cost-containment strategies that bundled quality measures with reimbursement, but were supportive of stand-alone measures to improve quality such as chronic disease management.
So what's the take home? Clearly, physicians who participated in this survey seem all too willing to cast blame and responsibility on others for soaring healthcare costs, are ready to embrace some changes to rein it in as long as they don't impinge on either income or ability to order tests one deems appropriate. Hmmm. As with so many aspects of American medicine, this is a moving target and we'll see what the future brings.
Other topics this week include the even more addictive power of menthol cigarettes, according to the FDA, the benefits of frequent debridement of wounds in JAMA Dermatology, and the role of screening echocardiography in JAMA Internal Medicine. Until next week, y'all live well.