If all U.S. physicians caring for Medicare fee-for-service (FFS) patients who meet quality criteria were to also meet cost-efficiency criteria in the future, and thus become high-value, the savings for Medicare FFS in 2020 alone would be $20.5 billion and $286.8 billion from 2020 to 2029––representing a 4% savings in total Medicare FFS spending, according to a report by UnitedHealth Group (UHG).
While the federal government bears a majority of the cost of care for Medicare beneficiaries, seniors pay for the remaining cost of their care through premiums, copays, and coinsurance. If more physicians caring for Medicare FFS patients become high-value and Medicare health spending declines as a result, seniors will also realize savings through lower premiums and out-of-pocket costs, reports UHG.
“Healthcare executives have a responsibility to address increasing healthcare costs and improve quality. This research aims to help move the needle,” says a UHG spokesperson. “Of all specialties evaluated in this study, primary care physicians see the highest volume of patients––58.7%. Therefore, primary care represents the greatest total savings opportunity––$14.5 billion by 2020 and $202.9 billion by 2029, from improving cost-efficiency of primary care physicians who already meet the quality criteria.”
Across the U.S. healthcare system, the per-patient or per-episode cost of care varies significantly among physicians within the same specialty. This variation in cost, driven by physician practice patterns and payment rates, may be a result of multiple factors including physician training and education, lack of transparency of cost differences by site of service, and physician employment and ownership arrangements, according to UHG.
The difference in the per-patient or per-episode cost of care delivered by high-value physicians versus other physicians varies by specialty. Across all specialties caring for Medicare patients, the average per-patient or per-episode cost of care delivered by high-value physicians was $596 (6.9%) lower than for other physicians, UHG reports.