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Little correlation found between quality of care and cost of physician services

by John W. Mitchell , Senior Correspondent
Contrary to conventional thinking, paying more to see an expensive doctor will not necessarily yield better results.

This was the finding of a study just published in the most recent issue of Health Affairs.

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One of the study authors told HCB News they looked at the issue in light of the increasing consolidation trend underway in the physician practice sector. Eric Roberts, Ph.D. a postdoctoral fellow at the Harvard Medical School of Health Policy, told HCB News that the solo practice model for practicing medicine is shrinking as doctors' offices merge into large multi-specialty groups.

"Larger practices often are able to negotiate higher prices with insurers, which ultimately makes them more expensive for consumers," said Roberts. "We wanted to see whether larger practices that negotiated higher prices actually provided better care for their patients."

The study reviewed Medicare patient survey data and health care claims for practices that provided some primary care services. These practices were classified as high-price or low-price.

The researchers discovered that high-price practices were nearly four times larger and received an average of $84.45 for an office visit, 36 percent more than the $62.06 that their low-price counterparts received.

Notably, there was minimal difference between the high and low-cost practices based upon a broad range of measures including patient experience, preventative care, acute care use and spending. The patients in high-cost practices fared slightly better for a few measures, including care coordination, receiving vaccinations, and shorter waiting times.

"Our results suggest that the benefits to patients of getting care in higher-priced physician groups are quite limited," said Roberts. "Further, our findings cast doubt on whether larger and pricier physician groups offer a value proposition to insurers and consumers — whether going to a more expensive doctor will improve care and ultimately save money by reducing patients' use of costlier hospital services."

According to Roberts, the study (which did not include concierge medicine practices) demonstrates the difficulty of applying general economic rules in medicine.

"In markets for most goods and services, intuition and economic theory both suggest that products differentiated on quality also differ on price," explained Roberts. "Our study shows that this intuition does not always hold up in the health care sector. A variety of factors might underlie this disconnect between price and quality."

These "disconnect" factors include: care in larger practices may be less personalized; patients are not price sensitive as their negotiated insurance rates influence their purchasing decisions; and patients often do not have an understanding of health care quality measures.

"As the landscape of quality reporting evolves, researchers and policymakers will be continuing to monitor the relationship between health care prices and quality," said Roberts.

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