The Non-Surprise of Increased Physician Referrals

Big deal!

News flash! 

In the last century, American derrieres have grown by 5%! 

In the last 20 years, rates of professional athlete misbehavior have skyrocketed! 

And in the last 10 years, there's been a near doubling of physician referrals!  

If these trends surprise and amaze you, you may want to check out the up-to-the-minute news outlets like The New York Times' "Prescriptions Blog."  On the other hand, regular readers of the Disease Management Care Blog may not need to go to such extremes. They are astute observers of backsides, know how to access ESPN and can confidently predict trends in health care utilization.

That being said, the DMCB thinks a recently published article on physician referrals may be worth a look.

Michale Barnett and colleagues extracted physician survey data on a sample of clinic visits from 1999 to 2009 that had been collected by the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.  Physicians were asked about their type of practice setting (employed vs. physician owned), their patients' demographic variables, reasons for the visit, diagnosis, treatment and disposition, including whether or not there was a referral to another physician.

The study found that the rate of referrals increased from 4.5% of visits in 1999 to 9.3% in 2009.  This increase included Medicare patients, who went from 4.2% to 9.7%.  Physicians who owned their practices were less likely to refer (from 4.2% to 7.5%) and physicians with more than 50% managed care experienced an increase from 5.5% to 8.7%.

In the Discussion section of the manuscript, the authors point out that two possible explanations for the increase in referrals include 1) the increasing complexity of health care and 2) the benefit of off-loading some of the work of patient care onto another colleague.

The DMCB agrees and would add two more explanations:

1. The increase in "PPO" vs. "HMO" style managed care during the period of study, and

2. An increase in patient consumerism.

Can recent health care reforms, like ACOs, reverse this referral trend?  While the DMCB awaits the answer to that question, it looks forward to the continuing roominess of its movie theater seats and the next juicy sports scandal.

Stay tuned!

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