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Doctors Can Help Lower Hospital Costs
Date:5/13/2008

'Gainsharing' gives physicians cash rewards to keep expenses down, researchers say

TUESDAY, May 13 (HealthDay News) -- Giving doctors cash rewards to reduce hospital spending helps control costs without compromising quality or patients' access to care, according to a five-year study that included more than 220,000 patients.

The study compared six cardiac catheterization labs that implemented this type of "gainsharing" program to 123 non-gainsharing labs.

The researchers, from Arizona State University, found that gainsharing reduced hospital costs by 7.4 percent, or $315 per patient. That means that nationwide use of gainsharing could slash hospital costs for coronary stent patients by about $195 million a year, according to the researchers.

Most of the savings from the gainsharing programs in the study were the result of lower prices for coronary stents. The gainsharing programs didn't lead to any changes in patient referral patterns and didn't increase the overall risk of in-lab complications. In fact, the gainsharing programs were associated with significant decreases in three specific types of complications, the researchers said.

"We found no evidence that gainsharing prompted physicians to avoid patients with existing health problems or pick the healthiest patients," study author Jonathon Ketcham, an assistant professor at the university's School of Health Management and Policy, said in prepared statement.

Further research into gainsharing's effects on other health care quality measures and how it influences doctors' decisions would be valuable, he added.

The study is published in the May/June issue of the journal Health Affairs, a themed issue on health-care reform.

Another study in the issue concluded that doctors in Massachusetts don't face a malpractice premium crisis -- even though the state has the fourth-highest median malpractice settlement payments in the country. Nearly all physicians in the state paid lower inflation-adjusted malpractice premiums in 2005 than in 1990. The findings challenge popular perceptions and assumptions behind legislative proposals to cap malpractice damages awards, said the Suffolk University Law School researchers.

In another study that included a survey of more than 800 doctors, researchers found that primary-care physicians in high-spending health-care regions have more frequent patient return visits, are more likely to recommend screening tests of uncertain benefit, and opt for more resource-intensive management strategies than doctors in low-spending health-care regions.

"Current policy efforts to improve the quality of care and address disparities in spending have focused largely on fostering adherence to clinical guidelines," wrote researcher Brenda Sirovich of the Veterans Affairs Medical Center in White River Junction, Vt., and colleagues. "This study suggests that greater attention to clinical judgment -- and to local factors that are likely to influence physician practice -- will be required."

More information

There's more on U.S. health-care costs at the National Coalition on Health Care.



-- Robert Preidt



SOURCE: Health Affairs, news release, May 13, 2008


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