It's not uncommon for physicians to refer patients to specialists that they know, thus creating an unofficial referral network. These networks may influence patient admission rates to hospitals, according to research from Weill Cornell Medical School.
Researchers reviewed more than 384,000 Medicare claims from a random sample of Medicare beneficiaries in five states — including Ohio, Pennsylvania, Tennessee, Washington and Wisconsin — who were 65 years old or older. The team then created and applied algorithms to the claims data to identify direct and indirect connections among physicians.
All total, the researchers were able to identify 417 unofficial physician networks and found that the rate of ambulatory care sensitive admissions — potentially preventable admissions of patients with chronic diseases like congestive heart failure and asthma — varied significantly across the networks.
The research team also found that many hospitals receive patients from two separate unofficial networks that vary in performance and that patients who visit a physician in the lower-performing network are more likely to have a potentially preventable hospital admission than patients visiting physicians in the higher-performing network.
"If patients had this information, and knew which doctors are in the highest performing networks, it could influence their decision of which doctor to see," said the study's lead researcher, Lawrence Casalino MD, PhD. "Similarly, physicians might be interested in knowing which network they're in and how that network is performing."
The researchers also suggest accountable care organizations, hospitals and health insurers identify these physician referral networks, learn from the high-performing networks and work with lower-performing networks to improve the care they provide. Doing so may lead to lower healthcare costs and better patient outcomes.
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