In a 2021 op-ed, M. Susan Ridgely, an adjunct senior health policy researcher at the RAND Corporation and co-director of the RAND Center of Excellence on Health System Performance, said that changes in referral patterns over three years for just five common imaging and lab procedures triggered an increase in Medicare spending of $73.1 million.

Additionally, there was substantial variation, with some affiliated physician organizations performing better than unaffiliated ones and some not. She said more research on this is required, along with the development of strategies for clinical integration and standardization for better performance in these situations.


“More attention could be paid by health system executives to shortening the trajectory for care redesign and clinical integration: paying attention not only to the mechanics of care delivery, but also to governance, culture, and staff empowerment. At the same time, policymakers could better enable change,” she said.

Saghafian says that based on their findings, policymakers should pay more for services to correct the incentive system currently in place. “This additional expense would result in improvements to both patient well-being and the volume of patients cared for, and therefore would provide notable savings in the long term.”

For their inquiry, Saghafian and her colleagues used a causal model and large-scale patient-level national panel data that includes 2.6 million patient visits across 5,488 physicians.

The findings were published in the INFORMS journal, Management Science.

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