Panel: Provider Decision Making and Patient Outcomes
(Health Policy)

Friday, November 3, 2017: 1:30 PM-3:00 PM
Acapulco (Hyatt Regency Chicago)

*Names in bold indicate Presenter

Panel Organizers:  Hannah T Neprash, University of Minnesota
Discussants:  Lauren Nicholas, Johns Hopkins University and Coady Wing, Indiana University

The Effects of Time Pressure on Primary Care Physician Decision Making
Seth Freedman, Indiana University and Ezra Golberstein, University of Minnesota

Better Late Than Never? Physician Response to Schedule Disruptions
Hannah T Neprash, University of Minnesota

The Impact of Resource Constraints on Provider Behavior and Health Outcomes in Childbirth
Katherine Donato1 and Neel Shah1,2, (1)Harvard University, (2)Beth Israel Deaconess Medical Center

Physicians increasingly face pressure to do more with less time. Between a recent large increase in health insurance, an aging population with a growing burden of chronic disease, and complex reporting requirements, physicians’ services are in high demand and their time has become an increasingly scarce resource. Drawing on novel data sources and a range of empirical methodologies, this panel examines the effect of this time pressure on medical decision making and patient outcomes.

The first two papers examine the effect of time pressure on primary care physicians, exploiting detailed appointment schedule information to observe how physicians respond to unanticipated, but common shocks – including no-shows, same-day cancellations, walk-in appointments, and late patients. Results show that time-constrained primary care physicians spend less time with patients, perform fewer procedures, record fewer diagnoses, and refer patients to specialists more often. Time-constrained physicians also modify their prescribing behavior in ways of particular concern to policymakers, including increases in potentially inappropriate antibiotic and opioid prescribing.

            The third paper studies the behavior of busy physicians in a common inpatient setting: childbirth. Unlike the primary care context in which appointments are generally scheduled in advance, OBGYNs may be more or less busy, based on the number of women in labor at any given time. This paper finds that busy physicians are considerably more likely to perform discretionary Cesarean deliveries, particularly for patients at low risk of birth complications.

Taken together, these papers suggest that physicians respond to time pressure in ways that may increase health care spending and/or reduce the quality of care and negatively affect patient outcomes. The findings presented in this panel are particularly relevant for policymakers considering medical workforce adequacy and regulation.

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