• Hsiu-Chen Lin, Sudha Xirasagar, Herng-Ching Lin, and Yi-Ting Hwang.
• Department of Pediatric Infection, Taipei Medical University and Hospital, Taipei, Taiwan.
• J Gen Intern Med. 2008 Mar 1; 23 (3): 304309304-9.

BackgroundIncreasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not for medical conditions such as pneumonia that consume significant health care resources.ObjectiveThis study explored the association between physicians' inpatient pneumonia case volume and cost per discharge.DesignThe design was a retrospective, population-based, cross-sectional study, using National Health Insurance administrative claims data.SettingThe setting was Taiwan.ParticipantsThe participants were a universal sample of 270,002 adult, acute pneumonia hospitalizations, during 2002-2004, excluding transferred cases and readmissions.MeasurementsHierarchical linear regression modeling was used to examine the association of physician's volume (three volume groups, designed to classify patients into approximately equal sized groups) with cost, adjusting for hospital random effects, case severity, physician demographics and specialty, hospital characteristics, and geographic location.ResultsMean cost was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (< or =100 cases) and NT$1,707 for high-volume physicians (> or =316 cases). The adjusted patient costs for low-volume physicians were higher (US$264 and US$235 than high- and medium-volume physicians, respectively; both P < .001), with no difference between high- and medium-volume physicians. High-volume physicians had lower in-hospital mortality and 14-day readmission rates than low-volume physicians.ConclusionsData support an inverse volume-cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce costs.

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