Guest essay: Rochester health costs lower, thanks to physicians

The article published in the Albany Times Union on Sept. 8titled “Rochester Cited for Lowest Medicare Spending” seemed to suggest that the explanation for Rochester having the lowest Medicare spending in the country resulted from a group called the “regional advisory committee,” which purportedly lowered spending by “keeping the lid on” hospital expansion and technology upgrades such as MRI and PET scanners. Supply-sensitive variations such as these may account for some utilization trends, but they are not the main drivers of geographical spending variations.

It is known that the discretionary decisions made by physicians, which determine utilization of services, account for 70 percent of regional variation in Medicare spending. The remainder is accounted for by health status of the population, according to Dr. Elliott Fischer and his group at the Dartmouth Institute for Health Policy and Clinical Practice who have led the field of variations research. The majority of these decisions include “preference-sensitive” variations, which are not supply-dependent.

In a nutshell, lower spending is resulting from the decisions that Rochester physicians are making. Furthermore, Monroe County also happens to have the lowest malpractice premiums of any county in New York state.

Rochester physicians appear to be doing something right. The physicians play a key role in Rochester having the lowest Medicare spending (cost per beneficiary per month) in the United States.

The reasons for this are likely multifactored but certainly include an active and involved Medical Society, which has been at the forefront in promoting quality initiatives with our physicians since 2002. For example, 18 clinical guidelines have been developed by the Medical Society-led Quality Collaborative to help physicians manage common clinical conditions.

The Rochester community also has benefited from a uniquely cooperative nexus between the business and health care complex, creating a collaborative environment bringing together physicians, business, hospital and commercial insurance leaders to regularly discuss ways to improve health care in our community. This has resulted in less use of services in the Rochester area.

Fetten, a medical doctor, is president of the Monroe County Medical Society.