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Does Physicians’ Case Volume Impact Inpatient Care Costs for Pneumonia Cases?

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Summary

Background

Increasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not for medical conditions such as pneumonia that consume significant health care resources.

Objective

This study explored the association between physicians’ inpatient pneumonia case volume and cost per discharge.

Design

The design was a retrospective, population-based, cross-sectional study, using National Health Insurance administrative claims data.

Setting

The setting was Taiwan.

Participants

The participants were a universal sample of 270,002 adult, acute pneumonia hospitalizations, during 2002–2004, excluding transferred cases and readmissions.

Measurements

Hierarchical linear regression modeling was used to examine the association of physician’s volume (three volume groups, designed to classify patients into approximately equal sized groups) with cost, adjusting for hospital random effects, case severity, physician demographics and specialty, hospital characteristics, and geographic location.

Results

Mean cost was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (≤100 cases) and NT$1,707 for high-volume physicians (≥316 cases). The adjusted patient costs for low-volume physicians were higher (US$264 and US$235 than high- and medium-volume physicians, respectively; both P < .001), with no difference between high- and medium-volume physicians. High-volume physicians had lower in-hospital mortality and 14-day readmission rates than low-volume physicians.

Conclusions

Data support an inverse volume–cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce costs.

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Acknowledgments

This study was supported by a grant from the National Science Council (NSC 95-2416-H-038-001). This study is based in part on data from the NHI Research Database provided by the Bureau of NHI, Department of Health, and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of Bureau of NHI, Department of Health, or National Health Research Institutes.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Pediatric Infection, Taipei Medical University and Hospital, Taipei, Taiwan

    Hsiu-Chen Lin MD

  2. Arnold School of Public Health, Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA

    Sudha Xirasagar PhD, MBBS

  3. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

    Herng-Ching Lin PhD

  4. Department of Statistics, National Taipei University, Taipei, Taiwan

    Yi-Ting Hwang PhD

Authors
  1. Hsiu-Chen Lin MD
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  2. Sudha Xirasagar PhD, MBBS
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  3. Herng-Ching Lin PhD
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  4. Yi-Ting Hwang PhD
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Corresponding author

Correspondence to Herng-Ching Lin PhD.

Appendix

Appendix

Table 2 The Deyo–Charlson Index of 19 Comorbidities and the Assigned Weights
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Lin, HC., Xirasagar, S., Lin, HC. et al. Does Physicians’ Case Volume Impact Inpatient Care Costs for Pneumonia Cases?. J GEN INTERN MED 23, 304–309 (2008). https://doi.org/10.1007/s11606-007-0462-3

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  • DOI: https://doi.org/10.1007/s11606-007-0462-3

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