John P Caloyeras1, Michael H Kanter2, Nicole R Ives3, Chong Y Kim4, Hemal K Kanzaria5, Sandra H Berry6, Robert H Brook7. 1. Doctoral Fellow at the Pardee RAND Graduate School in Santa Monica, CA when this study was conducted. He is currently a Director of Global Health Economics for Amgen, Inc, in Thousand Oaks, CA. jcaloyer@amgen.com. 2. Executive Vice President and Chief Quality Officer of The Permanente Federation in Oakland, CA. He is the Regional Medical Director of Quality and Clinical Analysis for the Southern California Permanente Medical Group in Pasadena. michael.h.kanter@kp.org. 3. Group Leader in the Southern California Permanente Medical Group in Pasadena. nicole.r.ives@kp.org. 4. Practice Leader in the Southern California Permanente Medical Group in Pasadena. chong.y.kim@kp.org. 5. Assistant Professor of Clinical Emergency Medicine at the University of California, San Francisco. hemal.kanzaria@ucsf.edu. 6. Senior Behavioral Scientist at the RAND Corporation, where she is Chair of the Human Subjects Protection Committee, Senior Director of the Survey Research Group, and a Professor at the Pardee RAND Graduate School in Santa Monica, CA. berry@rand.org. 7. Distinguished Chair in Health Care Services and a Senior Principal Physician Policy Researcher at the RAND Corporation and a Professor at the Pardee RAND Graduate School in Santa Monica. brook@rand.org.
Abstract
BACKGROUND: Approximately 30% of total US health care spending is thought to be "wasted" on activities like unnecessary and inefficiently delivered services. OBJECTIVES: To assess the perceptions of clinic-based physicians regarding their use of time and appropriateness of care provided. DESIGN: Cross-sectional online survey of all Southern California Permanente Medical Group partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. MAIN OUTCOME MEASURES: The proportion of time spent on direct patient care tasks perceived to require the respondent's clinical/specialty training as a physician or another physician who has similar years of clinical training (vs physicians with fewer years of clinical training, nonphysicians, or automated or computerized systems), and the proportion of care provided by the respondent and by other physicians with whom they are familiar that is perceived to be appropriate (vs equivocal or inappropriate). RESULTS: More than 61% of respondents indicated that 15% of their time spent on direct patient care could be shifted to nonphysicians, and between 10% and 16% of care provided was equivocal or inappropriate. DISCUSSION: The low proportion of care perceived as equivocal or inappropriate indicates there is little room for reducing such care or that physicians have difficulty assessing care appropriateness. The latter suggests that attempts to reduce or to eliminate inappropriate care may be unsuccessful until physician beliefs, knowledge, or behaviors are better understood and addressed. CONCLUSION: On the basis of these findings, it is apparent that within at least one health care system, the opportunity to increase value through task shifting and avoiding inappropriate care is more narrow than commonly perceived on a national level.
BACKGROUND: Approximately 30% of total US health care spending is thought to be "wasted" on activities like unnecessary and inefficiently delivered services. OBJECTIVES: To assess the perceptions of clinic-based physicians regarding their use of time and appropriateness of care provided. DESIGN: Cross-sectional online survey of all Southern California Permanente Medical Group partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. MAIN OUTCOME MEASURES: The proportion of time spent on direct patient care tasks perceived to require the respondent's clinical/specialty training as a physician or another physician who has similar years of clinical training (vs physicians with fewer years of clinical training, nonphysicians, or automated or computerized systems), and the proportion of care provided by the respondent and by other physicians with whom they are familiar that is perceived to be appropriate (vs equivocal or inappropriate). RESULTS: More than 61% of respondents indicated that 15% of their time spent on direct patient care could be shifted to nonphysicians, and between 10% and 16% of care provided was equivocal or inappropriate. DISCUSSION: The low proportion of care perceived as equivocal or inappropriate indicates there is little room for reducing such care or that physicians have difficulty assessing care appropriateness. The latter suggests that attempts to reduce or to eliminate inappropriate care may be unsuccessful until physician beliefs, knowledge, or behaviors are better understood and addressed. CONCLUSION: On the basis of these findings, it is apparent that within at least one health care system, the opportunity to increase value through task shifting and avoiding inappropriate care is more narrow than commonly perceived on a national level.
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