Ordering decision and clinic cost variation among resident physicians

Area of Science:

• Health Services Research
• Medical Economics
• Clinical Practice Variation

Background:

• Physician ordering practices for patient services exhibit considerable variability.
• Understanding the drivers of this variation is crucial for healthcare cost containment.

Purpose of the Study:

• To analyze ordering variation among resident physicians in a continuity clinic setting.
• To identify patterns in service utilization based on physician spending levels.

Main Methods:

• Examined 4,991 continuity clinic visits involving patients with chronic medical conditions.
• Ranked 47 resident physicians by average charge per visit into high, medium, and low spending groups.
• Compared the frequency of ordering laboratory tests, x-rays, medications, and other services across physician groups.

Main Results:

• High-charge physicians averaged $164 per visit, medium-charge $124, and low-charge $97.
• Ordering variation was observed across numerous service categories, not limited to specific decisions.
• High-spending physicians demonstrated a tendency to order slightly more of nearly every item.

Conclusions:

• Physician ordering variation is pervasive, affecting multiple service types.
• The cumulative effect of small ordering differences among high-cost physicians significantly impacts overall healthcare expenditure.
• Cost-containment initiatives may need to target the decision-making patterns of physicians with higher overall spending.