To the Editor.
—The often quoted interpretation from Dr Greenfield and colleagues1-3 that endocrinologists are high-cost providers is open to criticism. Because outcomes were not controlled for specific practices of the endocrinologist or their system of care, it would be more appropriate to confine the interpretation of cost only to systems of care and not to physician type.Interpretation of the cost data in the MOS1,2 was stratified for patient mix for a severity index (physical function index) reported by physicians (not disease specific). Using physician-reported severity of illness is influenced by the interpretation of the physician. Specialists in cognitive fields often underrate the complexity and severity of illnesses for patients seen. A more objective measure of severity of illness in the outpatient setting is needed. Also, the data of Greenfield et al support the observation that patients with diabetes generate greater costs whether they are seen by
Smith SA. The Medical Outcomes Study. JAMA. 1996;275(14):1084. doi:10.1001/jama.1996.03530380025016