Urological Survey Socioeconomic Factors, Urological Epidemiology and Practice Patterns Re: Physicians with the Least Experience have Higher Cost Profiles than do Physicians with the Most Experience

available at http://jurology.com/ Editorial Comment: This article is certainly provocative. The real question is not whether less experienced physicians have higher cost profiles, but why. The authors suggest 2 possibilities. One explanation is that this finding may be real, and less experienced physicians expend more resources when caring for patients. If this is the case, where do they expend more resources? It appears that as a total proportion of expenditures, these less experienced providers have similar use of costly procedures and medications (expressed as average percentage of total costs) to their more experienced colleagues. In fact, the less experienced physicians actually incur lower costs for imaging, so where do they run up the bill? They appear to have higher expenditures for evaluation and management visits, which means they spend more time with their patients. Could it be that this is high quality care that just happens to cost more? The authors did not look at quality of care or outcomes, just cost of care, which probably should never be considered in isolation. The other explanation for the findings is that the case mix for less experienced physicians may be different than for their more experienced colleagues. Despite these valid concerns, the authors conclude that “it is possible that one driver of rising health care costs overall is that the newly trained physicians have a more costly practice style.” Instead of really trying to figure out what is going on and improve the quality of care in a cost-effective manner, these authors have decided to throw the next generation of physicians under the bus. David F. Penson, M.D., M.P.H. Re: Insights from Transformations Under Way at Four Brookings-Dartmouth Accountable Care Organization Pilot Sites B. K. Larson, A. D. Van Citters, S. A. Kreindler, K. L. Carluzzo, J. N. Gbemudu, F. M. Wu, E. C. Nelson, S. M. Shortell and E. S. Fisher Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire Health Aff (Millwood) 2012; 31: 2395–2406. Abstract available at http://jurology.com/ Editorial Comment: This article provides fascinating insight into the variety of ways accountable care organizations can be structured and leveraged to provide health care to large populations of patients. As I read this article, I was struck by 2 important issues, 1 explicitly stated and the otheravailable at http://jurology.com/ Editorial Comment: This article provides fascinating insight into the variety of ways accountable care organizations can be structured and leveraged to provide health care to large populations of patients. As I read this article, I was struck by 2 important issues, 1 explicitly stated and the other 0022-5347/13/1901-0218/0 http://dx.doi.org/10.1016/j.juro.2013.03.090 THE JOURNAL OF UROLOGY Vol. 190, 218-219, July 2013 © 2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC. Printed in U.S.A.