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Physician-Level Variation in ED Admission Rates Among Medicare Patients

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A new study published this month in Health Affairs examined the variation in emergency department (ED) admission rates among medicare patients to establish the rate of physician-level variation.

Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood.

In this study researchers examined physician-level variation in ED admission rates for Medicare patients. They found meaningful variation in admission rates: The mean physician-level adjusted admission rate was 38.9 percent and ranged from 32.2 percent to 45.6 percent for physicians at the tenth and ninetieth percentiles, respectively, of the estimated distribution within the same hospital. In contrast, the predicted risk for admission based on patient characteristics varied little among these physicians, suggesting that the variation in admission rates was not due to differences in patients seen.

The study results suggest that strategies targeting physician decision making could modify (by either increasing or decreasing when appropriate) rates of admissions.

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