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Estimating the Value Added of Attending Physicians on Patient Outcomes

Author

Listed:
  • 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).

Suggested Citation

  • Jason M. Fletcher & Leora I. Horwitz & Elizabeth Bradley, 2014. "Estimating the Value Added of Attending Physicians on Patient Outcomes," NBER Working Papers 20534, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:20534
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    Cited by:

    1. Sammy Zahran & David Mushinski & Hsueh‐Hsiang Li & Ian Breunig & Sophie Mckee, 2019. "Clinical Capital and the Risk of Maternal Labor and Delivery Complications: Hospital Scheduling, Timing, and Cohort Turnover Effects," Risk Analysis, John Wiley & Sons, vol. 39(7), pages 1476-1490, July.
    2. Christian Posso & Jorge Tamayo & Arlen Guarin & Estefania Saravia, 2024. "Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes," Borradores de Economia 1269, Banco de la Republica de Colombia.
    3. Schiltz, Fritz & Sestito, Paolo & Agasisti, Tommaso & De Witte, Kristof, 2018. "The added value of more accurate predictions for school rankings," Economics of Education Review, Elsevier, vol. 67(C), pages 207-215.
    4. Jason Abaluck & Mauricio Caceres Bravo & Peter Hull: & Amanda Starc, 2021. "Mortality Effects and Choice Across Private Health Insurance Plans," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1557-1610.
    5. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    6. Raffaella Giacomini & Sokbae Lee & Silvia Sarpietro, 2023. "A Robust Method for Microforecasting and Estimation of Random Effects," Papers 2308.01596, arXiv.org.
    7. Jonathan M.V. Davis & Jonathan Guryan & Kelly Hallberg & Jens Ludwig, 2017. "The Economics of Scale-Up," NBER Working Papers 23925, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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