Physicians' Hospital Visits

Medicare's resource-based fee schedule and national volume performance standards aim to improve equity in payment to physicians and contain costs. Since physicians provided 2.5 million more hospital visits in 1988 than in 1986, this study sought to provide a description of the determinants of how often physicians provide hospital visits and to present a baseline for studying changes in the volume of hospital visits. This study used 1986 physician claims linked to inpatient hospital claims to determine the rate of visits provided to Medicare beneficiaries over the course of their hospital stay. It used a 1 percent sample of beneficiaries to determine rates of visits per hospitalized beneficiary and a 5 percent sample of physicians to determine rates of visits per physician practice. The study found that rates of hospital visits decline with longer lengths of stay and that this decline was larger for patients with more than one physician providing care. Also, an additional physician providing visits does not lead to a doubling of visits, but rather increases the rate by about 30 percent, and variation exists in the rate at which individual physicians or physician practices provide visits. These results suggest that physicians are not inappropriately billing a routine daily visit for each day of their patient's hospital stay, but that the rate of hospital visits varies by the type of care, collaboration with other physicians, and other factors the study could not measure.