Why employers with dispersed workforces should care about physician quality
November 07, 2017
By Dr. Sohini Stone
Geography can play a significant role in physician quality — the nation’s top doctors tend to be concentrated in metropolitan areas near major academic medical centers.
For employers with highly dispersed workforces in rural or remote areas, these disparities are both dangerous and costly — especially considering that physicians influence 35 percent of total health care costs in the U.S.
Too often, health care decisions are made by physicians who may not be qualified or familiar enough with particular conditions to make accurate diagnoses. Also, consumers don’t have sufficient information to ensure they are selecting the best physician and treatment path. It’s a problem that poses risks for both employees who live in remote regions, where physician quality is often questionable, and employers who have workers dispersed across wide areas.
A Better Understanding
To improve employee health care quality and outcomes, employers need to gain a better understanding of their employees’ health care decisions and implement programs that encourage smarter decision-making no matter where the employee is located.
Taking a data-driven approach to helping employees, and their families, find the most qualified doctor and appropriate treatment for their specific needs, regardless of where they live, is one way to meet this need. Over the past five years, Grand Rounds has analyzed more than 96 percent of the physicians in the U.S., using more than 7 billion data points, on many predictive measures of physician performance, including training quality, treatment patterns, patient volumes, procedure volumes and medical outcomes. Not surprisingly, regions with better access to top physicians tend to have the best outcomes. Additionally, studies have found that 77 percent of rural counties are experiencing shortages of primary health professionals and that these residents are more likely to report fair to poor health.
Massachusetts and Arkansas
For example, in the Boston area, there are 145 high-quality orthopedists — those who rank in the top 20 percent in their field, as determined by Grand Rounds’ analysis. This density is driven, in part, by the proximity to Massachusetts General Hospital and Brigham and Women’s Hospital, two of the premier teaching hospitals in the world, and the medical schools at Harvard University, Boston University and Tufts University. Boston is also a major metropolitan hub in a state with the lowest uninsured (4 percent) rate in the country.
Conversely, Little Rock, Ark., has a population of 130,000 adult residents — approximately one-eighth the adult population density of Boston. The uninsured rate for the state of Arkansas is more than twice that of Massachusetts. The absence of premier teaching hospitals and medical schools likely contributes to a scarcity of high-quality physicians.
Such disparities are both dangerous and costly. The lack of access that employees and their families have to quality physicians can result in higher complication, readmission and mortality rates. For example, a 2005 study conducted by the American Cancer Society looked at prostate cancer patients across a wide geographic area. The conclusion: The location of the patient has a 10 percent to 30 percent impact on mortality, and the study authors suggested a correlation between the results and access to medical care. Likewise, a 2012 study conducted by researchers at the University of California-Davis links lower mortality rates to greater access to high-quality health care.
Significant Risks
For benefits leaders with highly dispersed workforces in remote areas, the costs associated with low-quality physician care can go unnoticed when reviewing the company’s total health care trend. Most benefits teams don’t have the time or resources to investigate each physician, particularly when employees are visiting lesser-known and sometimes less-experienced medical providers. Yet, understanding the cost impact of low physician quality is a critical component to controlling health care costs. With 35 percent of total health care costs under the immediate influence of physicians, the risks that substandard care can bring to employees and their families are significant.
Patients who receive treatment from lower-quality physicians will increase systemwide medical expenses because of higher complication rates, and use of unnecessary tests and prescriptions, which contributes to the $300 billion U.S. employers waste on health care annually.
About the author: Sohini Stone, M.D., is the medical director of quality and continuous improvement at Grand Rounds.
Geography can play a significant role in physician quality — the nation’s top doctors tend to be concentrated in metropolitan areas near major academic medical centers.
For employers with highly dispersed workforces in rural or remote areas, these disparities are both dangerous and costly — especially considering that physicians influence 35 percent of total health care costs in the U.S.
Too often, health care decisions are made by physicians who may not be qualified or familiar enough with particular conditions to make accurate diagnoses. Also, consumers don’t have sufficient information to ensure they are selecting the best physician and treatment path. It’s a problem that poses risks for both employees who live in remote regions, where physician quality is often questionable, and employers who have workers dispersed across wide areas.
A Better Understanding
To improve employee health care quality and outcomes, employers need to gain a better understanding of their employees’ health care decisions and implement programs that encourage smarter decision-making no matter where the employee is located.
Taking a data-driven approach to helping employees, and their families, find the most qualified doctor and appropriate treatment for their specific needs, regardless of where they live, is one way to meet this need. Over the past five years, Grand Rounds has analyzed more than 96 percent of the physicians in the U.S., using more than 7 billion data points, on many predictive measures of physician performance, including training quality, treatment patterns, patient volumes, procedure volumes and medical outcomes. Not surprisingly, regions with better access to top physicians tend to have the best outcomes. Additionally, studies have found that 77 percent of rural counties are experiencing shortages of primary health professionals and that these residents are more likely to report fair to poor health.
Massachusetts and Arkansas
For example, in the Boston area, there are 145 high-quality orthopedists — those who rank in the top 20 percent in their field, as determined by Grand Rounds’ analysis. This density is driven, in part, by the proximity to Massachusetts General Hospital and Brigham and Women’s Hospital, two of the premier teaching hospitals in the world, and the medical schools at Harvard University, Boston University and Tufts University. Boston is also a major metropolitan hub in a state with the lowest uninsured (4 percent) rate in the country.
Sohini Stone, M.D.
Such disparities are both dangerous and costly. The lack of access that employees and their families have to quality physicians can result in higher complication, readmission and mortality rates. For example, a 2005 study conducted by the American Cancer Society looked at prostate cancer patients across a wide geographic area. The conclusion: The location of the patient has a 10 percent to 30 percent impact on mortality, and the study authors suggested a correlation between the results and access to medical care. Likewise, a 2012 study conducted by researchers at the University of California-Davis links lower mortality rates to greater access to high-quality health care.
Significant Risks
For benefits leaders with highly dispersed workforces in remote areas, the costs associated with low-quality physician care can go unnoticed when reviewing the company’s total health care trend. Most benefits teams don’t have the time or resources to investigate each physician, particularly when employees are visiting lesser-known and sometimes less-experienced medical providers. Yet, understanding the cost impact of low physician quality is a critical component to controlling health care costs. With 35 percent of total health care costs under the immediate influence of physicians, the risks that substandard care can bring to employees and their families are significant.
Patients who receive treatment from lower-quality physicians will increase systemwide medical expenses because of higher complication rates, and use of unnecessary tests and prescriptions, which contributes to the $300 billion U.S. employers waste on health care annually.
About the author: Sohini Stone, M.D., is the medical director of quality and continuous improvement at Grand Rounds.