The authors conclude that the weak association they found between price and the quality of care calls into question providers’ claims that their higher prices signal higher-value care.
The study found that high-price practices were much larger in size than low-price practices, suggesting that “larger provider groups with market power are able to command substantially higher prices without having to offer markedly better care than smaller practices,” the authors say.
“There’s a widespread conception that bigger is better, and all of this leads to better outcomes for patients,” says senior author Dr. J. Michael McWilliams, a professor of healthcare policy at Harvard Medical School.
“We know it leads to higher prices. What has been less clear is whether it has led to higher quality,” he tells Reuters Health. “And we’ve convincingly shown that large-scale consolidation does not benefit patients.”
Large practices, with on average 155 clinicians, charged 20% more on average for office visits than small ones, which had an average of 11 clinicians, the study found. Like patients in high-priced practices, patients in large practices reported shorter time spent in waiting rooms before seeing doctors, better care coordination and management and that they were more likely to receive pneumonia and flu vaccines than patients in small practices.
But patients perceived their care similarly in small and large physician practices, except that overall ratings of care tended to be worse in large practices than in small ones.
“Small practices in many ways do as well as large practices,” Gaynor says. “Bigger is not necessarily better. Sometimes bigger is worse.”
Reference
- Roberts ET, Mehrotra A, McWilliams JM. High-price and low-price physician practices do not differ significantly on care quality or efficiency. Health Aff (Millwood). 2017 May 1;36(5):855-864. doi: 10.1377/hlthaff.2016.1266.
