Clinician Productivity & Veterans’ Access to Specialty Care

Wednesday, June 26, 2019: 8:30 AM
Taylor - Mezzanine Level (Marriott Wardman Park Hotel)

Presenter: Christine Yee

Discussant: Austin Frakt

Veterans can experience long wait times to see a health care provider within the Veterans Health Administration (VHA). Long wait times have been a driving factor in the passage of the Veterans Choice Act and MISSION Act, which pay for the care that veterans receive from non-VHA or community providers. However, an alternative solution to the access problem could be making the VHA more efficient. In this study, we introduce new data on wait times for specialty care consult appointments at the VHA. Specifically, we compiled the wait times for cardiology consult appointments at the 129 VHA medical centers in the U.S. between fiscal years 2014 and 2016. We develop theoretical and empirical models of monthly average wait times for these appointments. Using an instrumental variables approach to handle endogeneity issues, we investigate the joint effect of physician capacity and productivity on wait times for specialty care while controlling for veteran characteristics, local area characteristics, facility fixed effects, and national changes over time and across seasons.

We estimate that a 10% increase in the average physician productivity at a given facility (or 26 RVUs per physician FTE-month) would reduce wait times by 0.26 days. Moreover, a 10% increase in the average number of cardiologists per 1,000 enrollees at a given facility (or hiring 0.006 more cardiologist per 1,000 enrollees) would reduce wait times by 4.3 days. The results suggest that the VHA could potentially see a larger improvement in access per dollar spent from the extensive margin (hiring clinicians) than from the intensive margin (productivity). Computing the cost-effectiveness ratios for the extensive and intensive margins (under certain assumptions), we found that a one-day reduction in wait time would cost $16,600 if applied to hiring more cardiologists and $78,300 if applied to increasing salaries (assuming a linear relationship between RVU production and a dollar of salary).