"The Battle over Obamacare is over," ABC news host Diane Sawyer pronounced Tuesday night, shortly after President Obama won re-election. For all the disgruntled docs out there, the not-so-close victory over former Massachusetts Gov. Mitt Romney sealed it.
For physicians unhappy with the President's healthcare policies, the battle may be over on the outside, but they may be seething on the inside.
Throughout the presidential campaign, many older physicians, in particular, expressed displeasure with regulations and financial cutbacks. Some talked privately about considering early retirement and others vowed to outright quit in the event of an Obama victory.
A month before the election, a survey of more than 4,600 physicians in the U.S. favored Romney by a 53%-to-33% margin, with 12% undecided and others supporting third party candidates, according to MDLinx, the healthcare information firm.
But like the rest of the country, physician specialists were extremely divided among themselves over who should win the presidency.
Hospital-based physicians preferred President Obama by a 47%-to-37% margin, with 12% undecided and the remainder preferring other candidates, MDLinx said. On the other hand, likely voters among solo practitioners expressed a two-to-one preference for Romney.
As physician practices got smaller, "each step down in size showed an additional shift toward the Republican candidate," Stephen Smith, the CMO for MDLinx said in a statement.
Now with the Obama re-election, a greater number of older physicians in particular, may consider exercising their options, such as quitting. But it certainly is a time to pause and a time to begin healing a divided country, and a divided profession.
It is time to get beyond the politics and into improved care and efficiencies of care, in spite of—if not because of—healthcare reform.
In that spirit, a Health Affairs report released this week shows the importance of the attitudes of older physicians in providing cost-cutting care that, as healthcare reform evolves, the country certainly needs.
In a study of health plans and Medicare use, Ateev Mehrotra, MD, a RAND policy analyst, and his colleagues found that physicians with fewer than 10 years experience had 13.2% higher overall costs than physicians with 40 or more years of experience.
The study results "raise the possibility that more costly practice styles of newly trained physicians may be a driver of rising healthcare costs overall," Mehrotra, wrote. He is an associate professor of medicine, division of general internal medicine at the University of Pittsburgh School of Medicine.
The cost-cutting ability of physicians is coming under increasing scrutiny. Health plans and Medicare are beginning to identify the costliest physicians, in hopes of crafting policy interventions to reduce overall spending, Mehrotra says. That is being done through physician "cost profiles," which provide a picture of the interventions performed by different physicians.
Not only that, but the cost profiles may be used as a basis for adjusting a physician's reimbursement via Medicare's new value based payment modifier under the Affordable Care Act, Mehrotra adds.
Surely, nearly everyone in the medical field agrees that in younger physicians, many see hope that more are technologically advanced, and more in tune with the multidisciplinary teams so desperately needed for improved quality and efficiencies. But don't count the older physicians out when it comes to saving money for delivery of care, says Mehrotra.
The study focused on physicians included in the Massachusetts Health Quality Partners database - some 12,704 physicians involved in 27 specialties. The physician performance scores were used from insurance claims from 1.13 million patients who were enrolled in four health plans in Massachusetts from 2004 to 2005.
Specifically, the study found that mean per-capita patient costs were $14,906 for physicians with fewer than 10 years of experience. Those with more than 40 years of experience had costs of $10,104. "When you think of the $2 billion spent overall for healthcare, those figures for each physician are significant," Mehrotra says. There was no association between the care costs and malpractice claims or the size of the physician group, he adds.
"The results raise the possibility that (the) more costly practice style of newly trained physicians may be a driver of rising healthcare costs overall," says Mehrotra in the report. "We found a large association between physician experience and lower cost profiles," he adds.
So what about that "costly practice style" of newly trained physicians? For one thing, physicians with less experience may spend more on patients who may need more costly care to begin with, and add to it.
"The higher mean patient costs observed among physicians with less experience appears to be driven by high-cost outlier patients," Mehrotra's report states.
When I interviewed him, Mehrotra theorized several possibilities of why younger physicians spent more than older doctors. "There may have been a situation that reflects clinical uncertainty (among the younger physicians), with them saying, ‘Let's get this test just in case," he says. "A physician who has experience and faced similar clinical situations previously may feel more comfortable just being conservative and watching things through."
Less experienced physicians may follow "costlier practice patterns" than more experienced physicians because recently trained physicians may be "more familiar with and therefore more likely to use newer and more expensive treatment modalities," Mehrotra says in the report. "It is also possible that lack of experience and uncertainty translates into more aggressive care.
As the government moves toward value-based care, physicians with higher costs may sustain reduced reimbursement. In addition, "less experienced physicians will, on average, be negatively affected by policies that use physician cost profiles unless they modify their practice patterns," he adds.
Mehrotra says that the study is significant because previous studies on the relationship between practice patterns and physician experience are mixed. Several studies have found lower rates of diagnostic testing among more experienced physicians, but other studies have found the opposite relationship between experience and services, such as electrocardiograms, Mehrotra says.
"Although winners and losers are inevitable in any cost profiling effort, physicians with less experience are likely to be negatively affected by policies that use cost profiles unless they change their practice patterns," Mehrotra wrote.
He says that physician-training programs should focus more attention on cost-efficiencies. "Postgraduate training programs and specialty boards need to educate physicians on their responsibility to be good stewards of healthcare resources."
"It is conceivable that as they gain more experience these same physicians may develop less costly practice patterns," he adds. One of the ways they can do that is through multi-disciplinary approaches that many hospital systems are embarking on—true partnerships focusing on quality and efficiency, Mehrotra told me.
Like this week's elections, he adds, "winners and losers" are inevitable in any cost profiling effort. And, coordinated care is needed among young and older physicians because, for one thing, healthcare reform is well on its way, with Romney's vision of it being erased, gone with his defeat.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
