Healthcare utilization varies greatly by geographic location. But it can also vary within the same city or small town – it really depends on the physician. At Compass, we have access to a wealth of healthcare statistics, and we can use information to learn more about healthcare utilization.
The Dartmouth Atlas of Healthcare is a famous source of data about healthcare utilization. For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States.
For example, the Dartmouth Atlas shows that Medicare patients receive more care in some parts of Texas, Louisiana and Florida and less care in parts of Wisconsin, Washington and California. This variation is NOT because Medicare patients are sicker in certain parts of the country. Instead, it is caused because physicians‘ practice patterns vary in different parts of the country.
Harvard surgeon and researcher Dr. Atul Gawande has also written about this topic. I wrote a blog about Dr. Gawande’s article in the May 2015 issue of the New Yorker magazine entitled, “Overkill: An Avalanche of Unnecessary Medical Care is Harming Patients Physically and Financially. What Can We Do About It?” that looked at the prevalence of unnecessary care in McAllen, Texas and how he saw this change when he revisited the community six years later.Healthcare utilization varies by geography. But it can also vary in the same town - it depends on the Dr. Click To Tweet
But what about variation within a city or metropolitan area? And can there be variation among doctors in the same town? The latter question directly impacts healthcare consumers, since most people choose to receive medical care close to home.
To answer this question, Compass examined 201 gastroenterologists (or GI doctors) in the Dallas-Fort Worth Metropolitan Area. We chose this specialty because our members often ask for pricing estimates for GI procedures.
Two of the most common GI procedures are upper GI endoscopies (also called esophagogastroduodenoscopies) and colonoscopies. These procedures involve sedating the patient and snaking a fiber-optic tube either into the patient’s mouth, esophagus and stomach or into the patient’s colon. The doctor uses a camera on the fiber-optic tube to view any lesions, such as ulcers or polyps. Endoscopies typically cost between $1,200 and $4,200, which includes the physician fee, facility fee, as well pathology fee and anesthesia fee (if appropriate).
Using data from patients with employee-sponsored health insurance coverage, we examined the number upper GI endoscopies and colonoscopies that each doctor performed over a 12-month period. It’s important to note that the number of endoscopies does not represent the total number of endoscopies doctors performed each year because it doesn’t include Medicare and Medicaid patients or insured patients whose employers didn’t provide us with their medical claims data.
We weren’t trying to determine the absolute number of endoscopies doctors in this community performed. Instead, we wanted to examine the variation in the number of endoscopies they performed.
Our research showed that six of the eight doctors who performed the most endoscopies were in the SAME practice. These six doctors performed between 165 and 123 endoscopies in a 12-month period. Across all 201 GI doctors, the range was 165 to 50 endoscopies, with median being 62.
This means that these six doctors performed nearly 160 percent more endoscopies than the ‘middle-of-the-pack’ GI doctors we researched.
The question is: Why did these physicians perform 160 percent more procedures? And was it a mere coincidence that they were all members of the same practice?
We had to ask ourselves: Did the practice pressure doctors to perform more procedures? Or was the practice financially incentivizing doctors to perform more endoscopies? It’s common for practices to measure physician productivity (as measured by a unit called an RVU—Relative Value Unit) and use this number as a basis for determining compensation and bonuses.
This is just speculation, but there is probably some underlying reason why six of the eight top ‘scoping’ GI doctors were in the same practice.
One possible reason for this variation could be that Compass’ data happened to be more concentrated for doctors in one practice than another practice. However, we see a fairly even distribution of claims across the metropolitan area, making this unlikely.
Another possible reason for this variation could be that a gastroenterologist we’ve identified as “top scoping” has more privately insured patients and fewer Medicare and Medicaid patients — and that the less frequently ‘scoping’ GI doctors happened to have more Medicare and Medicaid patients that Compass’ data just do not capture. This possibility could explain some variation, but I don’t think it would cause a 160 percent variation in the number of procedures performed.
What do these findings mean for healthcare consumers and employers:
- The likelihood that you will receive an endoscopy from a gastroenterologist may depend on which doctor you see locally and in which office that doctor practices.
- If you are an employer, the likelihood you are paying for an endoscopy that costs upwards of $4,200 may depend on which doctor your plan member sees locally and in which office that doctor practices.
Compass works with employees and their family members to avoid doctors who perform an excessive number of procedures. Certainly, if a procedure is necessary, it should be performed. However, if a procedure is not necessary, you wouldn’t want you or your family member to have a procedure simply because your doctor’s medical practice happens to perform a lot of them.
To learn more about Compass and how we help our members make better healthcare decisions, visit www.compassphs.com