Shopping for a Physician: Is Per Visit Costs Useful Information?

The growing interest in price transparency is reflected in the number of new state, health plan and private company initiatives. The goal of these initiatives is to provide the necessary cost data for patients, in particular those in high-deductible health plans, to choose where they receive care. In this study, we address whether the price data given to patients in price transparency efforts, per visit costs, is useful for patients when choosing a primary care provider (PCP). The concern is that physician practice style in frequency of visits, ordering of tests, or referral patterns trump any difference between PCPs in per visit costs. In other words a patient will not actually save any money by switching to a PCP with lower per visit costs.

We examined the relationship between PCPs per visit costs (combined health plan payment and co-payment) and measures of how much money patient will spend if they go to the PCP including average total patient costs, ED and specialty utilization, and overuse measures such as use of imaging for back pain. To do so, we analyzed 2009-2010 Ingenix data which includes claims data for 2.1 million enrollees across the nation with at least one PCP visit. We attributed patients to PCPs using visit patterns and then assigned PCPs to low, average, and high cost categories within each market (defined by hospital referral regions) based on their per visit costs for CPT 99213. We compared the care provided by physicians in the three groups to their assigned patients adjusting for patient demographic and number of conditions.

There were 84,543 PCPs with any patients assigned to them across 42 markets. In preliminary results, we find that no difference in costs of care between PCPs in the low, average, and high per visit cost categories. For example, the percentage of patients with an ED visit was 24%, 25%, and 23% across the low, average, and high cost categories. The fraction of patients who received unnecessary EKG tests at annual physicals was 70%, 71%, and 70% across the low, average, and high cost categories.

The goal of price transparency efforts is to help inform patient decision making and help them choose lower cost providers. Our preliminary results raise concern that the signal being provided to patients in price transparency efforts is not useful because it has little relationship with what the patients will pay for their care.