Working Paper: NBER ID: w20534
Authors: Jason M. Fletcher; Leora I. Horwitz; Elizabeth Bradley
Abstract: Despite increasing calls for value-based payments, existing methodologies for determining physicians' "value added" to patient health outcomes have important limitations. We incorporate methods from the value added literature in education research into a health care setting to present the first value added estimates of health care providers in the literature. Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).
Keywords: No keywords provided
JEL Codes: I11; I12
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Physician value added (75th percentile) (I11) | Patient length of stay (C41) |
| Physician value added (75th percentile) (I11) | Total hospital charges (I19) |
| Physician value added (75th percentile) (I11) | Health status at discharge (I12) |
| Physician value added (25th percentile) (J17) | Patient length of stay (C41) |
| Physician value added (25th percentile) (J17) | Total hospital charges (I19) |
| Physician value added (25th percentile) (J17) | Health status at discharge (I12) |
| Physician value added (I11) | 30-day readmission likelihood (I11) |