The use of in-hospital physician services for acute myocardial infarction. Changes in volume and complexity over time.

Changes between 1972 and 1982 in the use of in-hospital services were studied for 164 patients admitted with acute myocardial infarction. Resource use was measured in constant 1982 dollars adjusted for differences in clinical severity of the patients. Although average length of stay decreased by almost 40% during this period, the number of physician services doubled and total physician costs increased almost threefold. The increase in physician costs was due primarily to the use of complex diagnostic technologies and to the provision of coronary artery bypass graft surgery. The results of this study suggest that as hospital costs are constrained by prospective payment, physician costs may continue to rise as new diagnostic and therapeutic services are introduced into practice and as more care is shifted to the outpatient setting.