Physician Compensation – Page 4 – Healthcare Economist

Patient care under uncertainty: Or why I learned to stop loving clinical practice guidelines

2018-08-12Jason Shafrin1 Comment

The National Cancer Institute defines personalized medicine as “uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease”. In practice, however, patient treatment is rarely personalized by individual since evidence to support complete personalization is rarely available. Personalization in practice more often means care that varies with some individual characteristics.…

Why implementing pay-for-performance is challenging

2018-07-15Jason Shafrin2 Comments

Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement. At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP). They find…

Are hospitals gobbling up physician practices?

2018-07-11Jason ShafrinLeave a comment

Conventional wisdom holds that in recent years the answer is ‘yes’, however what does the data show? A paper by Nipay, Richards and Penso (2018) uses an SK&A survey of physician office practices between 2007 and 2017 to find the answer. In short, conventional wisdom is largely true with the caveat that there is significant…

When is physician failure a good thing?

2018-06-25Jason Shafrin1 Comment

How do physicians learn? A paper by Van Gestel, Muller, and Bosmans (2018) claims that the answer is through cumulative experience, economies of scale, or human capital depreciation. Learning from cumulative experience refers to the idea that treating an additional patient generally improves physician (or team) performance. When referring to economies of scale, we capture…

Do hospital purchases of physician practices increase or decrease prices?

2018-06-242018-06-27Jason Shafrin1 Comment

The effect of health care industry consolidation on prices is a question argued about by many including researchers, economists, anti-trust, lawyers, regulators and more. There is evidence that health plan consolidation increases premiums, and hospital consolidation increases price. For instance, Dafny et al. 2015 writes: The harsh reality is that it’s difficult to find well-documented…

Physician time spent on direct patient interaction, or: How I learned to stop talking to patients and start loving EHRs

2018-05-10Jason Shafrin2 Comments

Although this study about 18 months old, I just came across this and the findings were really surprising. During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9%…

The downside of medical homes

2018-03-05Jason Shafrin3 Comments

Integrated delivery networks (IDNs) and medical homes are all the rage among health wonks. The ability for patients to receive holistic are from multispecialty practice teams seems like it would be beneficial. While quality of care may (or may not) improve with more integrated care, provider consolidation may have one downside: higher prices. An NBER…

Is the physicians labor market recession proof?

2018-02-18Jason ShafrinLeave a comment

According to a Health Economics paper by Alice Chen, Anthony Lo Sasso, and Michael R. Richards, the answer is ‘yes’. According to their study: We leverage a unique dataset on New York physicians to analyze if and how the Great Recession impacted the labor market of physicians who have completed their residency and fellowship training and are…

Does the value-modifier improve quality and reduce health disparities?

2017-12-13Jason ShafrinLeave a comment

In short, no. That is the answer Roberts, Zaslavsky and McWilliams reach in their 2017 paper in Annals. Some background on the value modifier program. In 2013, practices with 100 or more eligible clinicians were rewarded just from reporting quality measures. By 2014, however: Practices with 100 or more clinicians were subject to upward, downward,…

Health insurance expansion and physician supply

2017-12-07Jason ShafrinLeave a comment

When new bills pass in Congress or state legislatures that expand health insurance coverage, most researcher look at the demand side effect. How does the insurance expansion affect the number uninsured? How does it affect access to care? How does it affect out of pocket cost? What is less frequently studied is the supply side…