Association Between Physician Propensity to Prescribe Opioids and Medicare Patient Panels’ Mean HCC Risk Scores
thesisposted on 01.10.2021, 20:55 by Carlo Duffy
Physician prescriptions might contribute to the opioid epidemic. We study the relationship
between average patient case complexity (mean HCC risk score) and physician opioid
prescription propensity. Among 100 physicians at one Minnesota hospital, North et al. (2017)
find evidence of a positive, linear relationship. However, using 2016 Medicare Part D data on
over one million physicians across the U.S., we find evidence of a relationship that often
increases within North et al.’s range of mean HCC scores, but then decreases and levels off
among higher mean HCCs that North et al. do not observe. Overall, we document wide variation
in this relationship across the most frequent specialties and by geography. We then introduce a
novel methodology for diagnosing each top specialty’s outlier states, whose relationships differ
noticeably from the specialty’s baseline model. Using a hypothesis-testing approach based on a
hierarchical linear model, we flag outlier states that vary widely by specialty. State-level
evidence suggests that unusual physician propensity transcends one region such as the Rust Belt.
Future research should build upon our model by using a more granular geographic level.