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P. Einzinger, R. Jung, N. Popper, N. Pfeffer, G. Zauner:
"Modeling the Effect of Group Practices on Medical Costs in Austria";
Poster: 15th Biennial European Meeting of the Society for Medical Decision Making, Antwerpen, Belgien; 08.06.2014 - 10.06.2014; in: "15th Biennial European Meeting of the Society for Medical Decision Making: ESMDM Meeting Abstracts", Medical Decision Making, 34 (2014), ISSN: 0272-989x; S. E38.

Purpose: In Austria, group practices of physicians from different specialties are possible but not well established. It is intended to reimburse them with per-case flat rates. We built a system dynamics model to analyze the change in medical costs that would result when 2 physicians form a group practice. The reimbursement system should be varied in 4 scenarios: (1) no change in the reimbursement system (the present fee-for-service system), (2) a cap of average reimbursement per case and discounts on certain services, (3) a per-case flat rate for all cases, and (4) a mixed system (a flat rate for joint group practice cases, and a cap on reimbursement for other cases).
Methods: The model simulates the patient consultations, provided medical services, and resulting income of the 2 group practice physicians. Remaining physicians from the same region and the same specialties as the group practice physicians are also simulated, but in an aggregated way. The main assumption is that in the group practice scenario, nearly all referrals of the group practice physicians go to their respective partner. To take into account that physicians will probably try to avoid excessive workloads and to reach a certain target income, we incorporated feedback effects of both the resulting workload and the income relative to a target income.
Results: We calculated results for 2 different specialty combinations (pulmonology and internal medicine, and general practice and internal medicine), each with data from 2 different regional health insurances. In all scenarios, the case numbers rose in comparison to the base case without the group practice, and they were highest in Scenario 3 (+21.4% at most). With most combinations, Scenario 1 led to the highest physician income (up to +17.6%), and Scenario 2 to the lowest. Costs per case were lower in the scenarios with reimbursement system change, but values differed between different combinations.
Conclusions: The quantitative effect of group practices on costs depends on the involved specialties as well as on the assumptions on physician behavior and tariff values for the alternative reimbursement systems. Qualitatively, most results suggest that group practices with per-case flat rates could lead to more cases and lower costs per case.

Group Practices, Physician Reimbursement, System Dynamics

http://dx.doi.org/10.1177/0272989X14547195