'Cowboy' doctors account for a lot of unnecessary care, Medicare expenditures

So-called "cowboy doctors"--clinicians who provide intensive, but unnecessary care--account for more than a third of all Medicare expenditures at the end of life and 12 percent of all Medicare expenditures overall, according to a new study by Harvard University researchers.

The term "cowboy doctors" are a contrast to what the study called "comforters"--doctors who provide palliative care near the end of life. Such doctors are likely to be male and practice in the South and Southeast, economist and study co-author David Cutler told Harvard Magazine.

The difference between the two kinds of doctors may explain the fact that price-adjusted per-patient Medicare expenditures by hospital referral region range from $6,876 in La Crosse, Wisconsin, to $13,414 in Miami--a nearly 100 percent difference between the regions.

The Medicare program is plagued by low-value care, which is believed to account for as much as $310 per beneficiary, or $8.5 billion, per year. And while there have been long-held notions that patient requests for additional testing and treatments drive this trend, research suggests otherwise.

Cutler likened the tug-of-war effect between cowboys and comforters to auto mechanics. "You want this engine fixed, I'll fix it. I'm not going to talk to you about whether you should get a new car--that's someone elses' job," he said. But that also leads to the patient being "ping-ponged back and forth" between his or her  primary care physician and specialist, neither of whom have any accountability for the medical bill. 

But Cutler also concluded that a lack of a financial penalty also prods many cowboy physicians to act the way they do. Meanwhile, most hospital performance programs also overlook the potential for overuse or overutilization of services. But the healthcare community is still struggling with an approach to reduce unnecessary care.

To learn more:
- read the Harvard study (.pdf)
- check out the Harvard Magazine article

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