The blame game: MDs say lawyers, insurers responsible for healthcare cost control

A majority of doctors abdicated “major responsibility” for reducing healthcare costs in a physician survey about cost control. They also expressed a lack of enthusiasm for eliminating fee-for-service payment models.

Results of the survey, which was designed to characterize physicians’ views about controlling healthcare costs, were published in the July 24/31 edition of JAMA.

Jon C. Tilburt, MD, MPH, of Mayo Clinic in Rochester, Minn., and colleagues, conducted a cross-sectional survey of 3,897 randomly selected U.S. physicians in 2012 and reviewed the 2,556 responses.

When asked which stakeholders bore major responsibility for controlling costs, respondents indicated that trial lawyers (60 percent), health insurance companies (59 percent), hospitals and health systems (56 percent) and pharmaceutical and device manufacturers (56 percent) topped the list. A mere 36 percent assigned major responsibility to practicing physicians.

Generic cost-containment strategies fared well, with 75 percent of respondents very enthusiastic for interventions such as “promoting continuity of care.” Many also liked the following strategies: expanding access to quality and safety data, promoting head-to-head trials of competing treatments and limiting corporate influence on physician behavior.

While there was lukewarm acceptance for limits on access to expensive treatments with little net benefit and using cost-effectiveness data to determine available treatments, readmission penalties and bundled payments garnered less support.

Eliminating fee-for-service payments, implementing Medicare payment cuts and reducing compensation to the highest paid specialties were downright unpopular, with 70 percent, 94 percent and 44 percent of respondents not enthusiastic, respectively.

The authors characterized physicians’ views about their perceived responsibility for healthcare costs as “inconsistent” and “nuanced.” Approximately three-fourths of physicians agreed with the following statements:

• Physicians “should be solely devoted to [their] individual patients’ best interests, even if that is expensive;”
• “Trying to contain costs is the responsibility of every physician;” and
• “Doctors need to take a more prominent role in limiting use of unnecessary tests.”

“Our data suggest that physicians struggle with navigating the tensions between their responsibilities to address overall health care resource use and their primary obligation to do what is best for individual patients,” wrote Tilburt and colleagues.

The authors suggested policy makers focus on cost-containment strategies that enjoy strong physician support, such as improving quality and efficiency of care and sharing transparent cost information and evidence from comparative effectiveness research in EHRs. They cautioned that more aggressive measures should be phased in and monitored as they may have a negative impact on individual clinical relationships.