​In a study of Medicare payments for patients undergoing coronary artery bypass grafting (CABG) procedures, higher levels of informal integration among physicians caring for the patient were associated with lower Medicare spending, reports an article in the December 27, 2017, issue of JAMA Surgery. Most programs to increase clinical integration among physicians examine formal models of physician integration, but in such programs, the reductions in Medicare spending have been "modest," the authors write. Further, formal integration does not reflect the reality of how physicians usually interact, they add. The researchers analyzed data for more than 250,000 Medicare beneficiaries undergoing CABG at 1,186 health systems. The data spanned four years. The researchers mapped interactions among all physicians within the health system who were involved in caring for the patients, from surgical and medical specialists to primary care physicians. This determined the level of informal integration among physicians for each patient, stratified into three tiers (low, medium, and high). The researchers adjusted for community, health system, and patient factors. After adjustment, high levels of informal integration were linked to significantly lower payments for the total episode of care and significantly lower payments for components of care (initial hospitalization, physician services, hospital readmission, and postacute care). Results in the high-level group showed the greatest percentage of savings for hospital readmissions (13% savings) and postacute care (6% savings). Integration level varied across health systems.

HRC Recommends: ECRI Institute has long espoused multidisciplinary involvement and a team approach as ways of ensuring that all factors in various patient safety and healthcare quality situations are considered and addressed. The current study also raises the question of whether they also make care more efficient and less costly. Risk managers may wish to evaluate current methods of promoting formal and informal interaction among physicians, plus ways to further such interaction.