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Saturday May 13, 2017

Bigger, more expensive healthcare practices not necessarily better

Bigger, more expensive healthcare practices not necessarily better

You might not get what you pay for when it comes to healthcare, a new study suggests.

A report in Health Affairs found little association between how much physician practices charged and patients’ perceptions of their quality of care.

“We’re asking consumers to make a lot of decisions about healthcare purchasing without a lot of information. Price is not really a definitive signal of quality,” said lead author Eric T. Roberts, a health-services researcher at Harvard Medical School in Boston.

“Practices with higher prices perform no better in terms of patients’ ratings of their care,” he said in a phone interview.

Working with nationwide databases, Roberts and his team looked at the fees practices had negotiated with commercial insurance companies. On average, high-price practices charged $84.45 for an office visit - 36 percent more than the charge at the average low-price practice, the study found.

Roberts and colleagues then looked at survey data and insurance claim information from more than 31,000 patients at those same practices who were insured through Medicare, the federal insurance policy for the elderly and disabled.

The researchers studied these patients because, under Medicare, the government sets non-negotiable fees. Medicare patients would have been unaware of the price differential and therefore would have been free from any influence of knowing the cost, making it easier for researchers to tell whether practices that negotiated above-average prices with commercial insurers for their non-Medicare patients delivered better care in general.

Medicare patients in high-price practices did report better coordination and management of their care, were more likely to see doctors within 15 minutes of scheduled appointments and were slightly more likely to receive flu and pneumonia vaccines. Otherwise, however, based on their survey responses, they didn’t feel they received more valuable care than patients in lower-price practices in the same geographic areas.

Researchers found no significant differences in overall ratings of care or doctors, timely access to care and interactions with primary physicians. Higher prices failed to lead to fewer hospitalizations, and patients in high-price practices were no more likely to get mammograms or other preventive or acute care.

The study debunks the myth that more expensive healthcare is superior healthcare, said Martin Gaynor, an economics and health policy professor at the Heinz College at Carnegie Mellon University in Pittsburgh.

“Don’t just assume that because this practice is more expensive, the care is going to be better,” Gaynor, who was not involved with the study, said in a phone interview. “There’s no consistent finding across the board that quality is better for patients who go to more expensive practices.”

The authors conclude that the weak association they found between price and the quality of care calls into question providers’ claims that their higher prices signal higher-value care.

The study found that high-price practices were much larger in size than low-price practices, suggesting that “larger provider groups with market power are able to command substantially higher prices without having to offer markedly better care than smaller practices,” the authors say.

“There’s a widespread conception that bigger is better, and all of this leads to better outcomes for patients,” said senior author Dr. J. Michael McWilliams, a professor of healthcare policy at Harvard Medical School.

“We know it leads to higher prices. What has been less clear is whether it has led to higher quality,” he told Reuters Health. “And we’ve convincingly shown that large-scale consolidation does not benefit patients.”

Large practices, with on average 155 clinicians, charged 20 percent more on average for office visits than small ones, which had an average of 11 clinicians, the study found. Like patients in high-priced practices, patients in large practices reported shorter time spent in waiting rooms before seeing doctors, better care coordination and management and that they were more likely to receive pneumonia and flu vaccines than patients in small practices.

But patients perceived their care similarly in small and large physician practices, except that overall ratings of care tended to be worse in large practices than in small ones.

“Small practices in many ways do as well as large practices,” Gaynor said. “Bigger is not necessarily better. Sometimes bigger is worse.”

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