Embold and Harvard Publish in JAMA Health Forum: Significant Physician Variation Exists within Communities

Significant Physician Variation Exists within Communities

Executive Summary

Embold Health recently conducted a physician quality research study in collaboration with Harvard Medical School and other leading institutions. Their findings were published in JAMA Health Forum, a publication of the highly respected Journal of the American Medical Association.

It’s been known in the medical community for decades that variations in physician quality exist from one region to another. Embold and Harvard researchers, led by Zirui Song, M.D., Ph.D., theorized that variation exists within regions as well, and that it stems from differences in how individual physicians care for similar patients. This hypothesis, if true, would be directly relevant to patient decisions and physician quality improvement.

The research discovered significant quality differences exist not only within regions but also within cities and even in the same practice groups. Some examples of key findings:

• The top-performing spine surgeons performed spinal fusions on patients with lower back pain at rates between 5.6 and 22.5 percent, while the lowest performing group in the same city performed them at much higher rates, between 57.3 and 79.2 percent of the time. This means a patient’s likelihood of having a major (and costly) back surgery can be 3-10 times higher, depending on one decision – which physician they see.
• Low-risk pregnant women who saw top-performing obstetricians were much more likely to give birth through natural delivery, with Cesarean births accounting for just 5 to 17.3 percent. Low-risk pregnant women treated by the lowest-performing doctors, however, proved much more likely to undergo a C-section, which happened 51 to 61.5 percent of the time. The research showed the odds of a mother delivering her baby via C-section vary dramatically depending not on her condition, but on which obstetrician she chooses.

Regarding these results, Song concludes, “This type of evidence, if replicated in a rigorous way, may also empower patients, employers, and payers to choose physicians who provide higher value care in their region, allowing consumers voting with their feet to stimulate practice improvement and competition on quality.”

This research supports Embold’s scientifically rigorous approach to measuring the quality of care delivered by different physicians. The information, paired with Embold’s tools, empowers employers, employees, health plans, consumers, and even the doctors themselves, to make better, more informed healthcare decisions.

“We’re excited to have JAMA Health Forum validate our methodology,” says Embold founder and CEO Daniel Stein, M.D. “We’re even more excited by the way our tools help people make more confident healthcare choices, because we believe everyone deserves to know they are receiving high-quality care.”

More about the Embold Study

We’re taking on research like our study published in JAMA Health Forum because we believe that everyone, no matter where they live, deserves the highest quality care. As a doctor-founded, doctor-led company, we’ve seen how the quality of care can vary and how those disparities have real implications for patients and families.

That’s why we measure physician quality as rigorously as possible and why we are committed to always sharing our findings openly and collaboratively. That’s how we are going to make healthcare better for all.

Establishing the Standard

Healthcare is complex and navigating the system can be confusing. How do we know how good an individual doctor is? Is the doctor across the street any better? How can you trust that you or your loved one is getting the best care?

Given the importance of health in our lives, not to mention the trillions of dollars spent on healthcare each year, you would think there must be recognized standards of quality among doctors – at least among those who work in the same office or hospital. Unfortunately, that’s not the case.

This cutting-edge research study confirms significant variation in the way physicians deliver care and the outcomes their patients experience in the same state, same city, and even within the same practice group.

We take our work down to the physician level because that’s where it’s most helpful and actionable. People often don’t have a choice about which insurance plan they have, but they do have a choice about what doctor they see. Until now, they’ve made that choice in the dark. We’re giving them something new, something that’s been missing: objective, reliable data.

Identifying the Problem

The published study conducted by the Embold Health measurement and data sciences team, researchers from Harvard Medical School, and other leading institutions, demonstrates how we use millions of data points and analytics to identify wide variations in care decisions among nearly 9,000 doctors in five distinct metropolitan areas.

“Publication of any study in peer-reviewed literature, and particularly a journal in the JAMA network, is a demanding process, but it provides important validation of our methods and findings,” says Embold Chief Medical Officer Matthew Resnick, M.D., MPH, one of the study’s authors. He noted that following an initial review by the editorial staff, the study successfully underwent a rigorous peer review by a panel of independent experts and was only accepted for publication by JAMA Health Forum after this exhaustive process.

Our study focuses on 14 common clinical situations involving seven medical specialties over a three-year period, which is how we determined that some patients are more likely to get spinal fusion surgeries and C-sections, and others are more likely to receive expensive tests when common, proven medications would have been more appropriate.

“We looked at a set of situations where clear-cut guidelines have been in place for years, with the hope of limiting variation in physician decision-making and promoting the use of the most appropriate care, based on rigorous evidence,”  said Song, the lead author of the study, in an article on the Harvard Medical School website. Song is an associate professor of healthcare policy at the school and an internist at Massachusetts General Hospital.

The study clearly reveals how the act of choosing a doctor can have profound consequences. In the medical scenarios covered by the study, specialists in the highest-performing group, when compared to those in the lowest-performing group, consistently choose the most appropriate care according to the latest quality measures and clinical guidelines.

It should be no surprise, then, that higher quality care leads to better outcomes and lower costs. Noting that some estimates suggest approximately 25 percent of healthcare spending in the U.S. is wasteful, Dr. Song adds in the article: “Researchers have long suspected that much of that waste lies in the variation of the appropriateness of care from one physician to another. This study offers evidence that this problem is large and widespread across specialties. ... This type of evidence, if replicated in a rigorous way, may also empower patients, employers, and payers to choose physicians who provide higher value care in their region, allowing consumers voting with their feet to stimulate practice improvement and competition on quality.”

Provider Guide – the Gold Standard for Quality

So, how does Embold gather evidence and measure quality in ways that can address this problem? We look at all the interactions between a doctor and patient and measure what matters according to the latest science and best practices. We take large quantities of anonymous patient data, run it through market-leading, clinically-based analytics, and deliver the results with the heart and soul of a trusted family doctor.

We call it Provider Guide, and it’s the gold standard for measuring physician quality and creating actionable information for all healthcare stakeholders.

But we do more than just share our findings. We share everything about how we arrived at them. No black boxes – just honest, objective and totally transparent information that consumers, employers, health plans and doctors themselves can use to make smarter decisions.

From guiding employees and their families to the right doctors, enabling employers to offer better benefits at a lower cost, showing health plans how to build stronger networks, to helping physicians understand how they can consistently achieve better patient outcomes – we’ve got the right information and the right solutions.

That’s important. Because we’re all in this together, and together, we can make healthcare better. Join us.

Read the full article in JAMA Health Forum: “Physician Practice Pattern Variations in Common Clinical Scenarios within 5 US Metropolitan Areas.”

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