Physician Profiling Research Articles

Reporting health care performance: learning from the past, prospects for the future.

In the USA, where public reporting of data on clinical performance is most advanced, comparative performance information, in the form of 'report cards', 'provider profiles' and 'physician profiling', has been published for over a decade. Many other countries are now following a similar route and are seeking to develop comparative data on health care performance. Notwithstanding the idiosyncratic nature of US health care, and the implications this has for the generalizability of findings from the USA to other countries, it is pertinent to ask what other countries can learn from the US experience. Based on a series of structured interviews with leading experts on the US health system, this article draws out the key lessons for other countries as they develop similar policies in this area. This paper highlights three concerns that have dominated the development of adequate measures in the USA, and that require consideration when developing similar schemes elsewhere. Firstly, the need to develop indicators with sound metric properties - high in validity and meaningfulness, and appropriately risk-adjusted. Secondly, the need to involve all stakeholders in the design of indicators, and a requirement that those measures be adapted to different audiences. Thirdly, a need to understand the needs of end users and to engage with them in partnerships to increase the attention paid to measurement. This study concludes that the greatest challenge is posed by the desire to make comparative performance data more influential in leveraging performance improvement. Simply collecting, processing, analysing and disseminating comparative data is an enormous logistical and resource-intensive task, yet it is insufficient. Any national strategy emphasizing comparative data must grapple with how to engage the serious attention of those individuals and organizations to whom change is to be delivered.

Free Software and Physician Profiling

Free Software and Physician Profiling

Free Software and Physician Profiling—Reply

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A practice-profiling system for residents.

Providers are increasingly evaluated and measured as part of quality, credentialling, and reimbursement programs, an approach often used by managed care organizations. However, these evaluations are rarely used in residency training, meaning that physicians entering practice have little experience or understanding of these measures. To address this issue, in 1998 the authors successfully developed a three-part practice-profiling system for internal medicine residents at their institution that includes measures of patient satisfaction, disease-management profiles for diabetes and hypertension, and an Internet-based faculty-evaluation program. The patient-satisfaction profile utilizes a ten-question patient survey that emphasizes physician-patient communication issues. The diabetes and hypertension disease-management profiles use the resident's own patients to profile process and outcome measures for common chronic ambulatory conditions. The faculty-evaluation profile is conducted over the Internet, and allows the resident to compare faculty evaluations with those of his or her peer group. Residents receive the profiles as a packet in a scheduled session with a faculty supervisor twice each year. A total of 120 residents are profiled annually for the above measures. Residents rated the program very highly, and found the profiling program to be instructive and effective feedback. As payers and regulators increasingly use physician profiling, residents will benefit from learning the strengths and weaknesses of profiling systems early in their training.

Effect of Physician Profiles and Academic Detailing on Cost and Utilization of Selective Serotonin Reuptake Inhibitors

OBJECTIVE: To evaluate the effect of physician profiles and academic detailing on cost and utilization of selective serotonin reuptake inhibitors (SSRIs) in a managed care population. DESIGN: A retrospective review of 153,072 SSRI pharmacy prescription claims from January 1997 through December 2000. SETTING: The health plan is a staff-model managed care organization (MCO) in the central Texas region with more than 150,000 members and over 500 participating physicians. INTERVENTIONS: (1) Physician prescribing (profile) reports were implemented in November 1998 and thereafter distributed quarterly to MCO physicians. (2) These reports were supplemented with academic detailing at a majority of the health plan clinics. (3) SSRI utilization data were added to the prescriber profile reports in the first quarter of 1999. MAIN OUTCOME MEASURES: Prescriptions (Rxs), patients (utilizing members), days of therapy, drug (ingredient) cost and member-months were measured. The principal outcome measures are SSRI share pe...

The development of resident "report cards" in the context of managed care education.

This article describes the development of residents' report cards as one component of a curriculum on physician profiling for primary care residents. Thirty-two first-year residents matriculating into family practice, internal medicine, pediatrics, and obstetrics-gynecology residency programs in 1998 were profiled. The patient information in the report cards was limited to data on a panel of Medicaid patients initially seen in the resident ambulatory care clinics. All subsequent patient care for that population was also included. The method was multi-step and complex, involving hospital billing personnel and cooperation with a managed care partner. A three-session educational program was developed to introduce the concept of physician profiling. The first session consisted of a panel discussion on managed care. The second session was devoted to a discussion of hypothetical physician profiles with inappropriate length of stays, days/1,000, low numbers of office visits combined with high urgent-care use, and high outpatient services utilization. Small groups of residents participated in a problem-identification process as if they were members of a group practice. Residents identified problems in the reports and made suggestions for behavioral changes. A final session presented residents with their own personal report cards. Residents were surveyed both at the beginning of their first year and before and after the educational intervention on profiling. Resident attitudes, which were negative toward managed care at the outset, became generally more positive. Comparisons of pre-test and post-test means on the five-point Likert scale, using a paired-samples t-test, revealed significant changes in the residents' attitudes overall.

Managing customer relationships through E-business decision support applications: a case of hospital–physician collaboration

Customer Relationship Management (CRM) is a valuable concept for hospitals to establish long-term physician relationships. Given predetermined reimbursement amounts, clinical interventions by physicians can significantly impact hospital profitability and quality. Therefore, disseminating quality and cost information to physicians can build lasting relationships, while insuring financial stability. This paper presents a CRM approach adopted by a hospital through a web-based Physician Profiling System (PPS). We discuss physician involvement in PPS development and present a high-level cost-benefit analysis. Post-deployment results indicate that PPS strengthened relationship with physicians, improved efficiency of clinical operations, while simultaneously improving patient satisfaction.

Physician Profiles in Africa

A Peace Corps physician in Africa profiles some of his physician colleagues working in Africa in his most recent online journal entry and encourages others to step into the field of international health. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Physician profiling

In some states, recent consumer-driven legislation is putting health care providers under close public scrutiny. Physician profiling, effective in New York in April 2001 and already in effect in Massachusetts and Florida, will make information regarding such matters as criminal convictions, medical board disciplinary actions, restrictions of hospital privileges, and malpractice events involving indemnity payments available to the public.

Impact of patient socioeconomic status on physician profiles: a comparison of census-derived and individual measures.

Patient education has been shown to affect physician performance profiles. It is not known whether census-derived measures of patient socioeconomic status (SES) show comparable effects. The objective of this study was to compare the effects on physician profiles for patient satisfaction and physical and mental health of adjustment for patient SES derived from patient addresses geocoded to the census block group level, zip codes, and patient education. This was a cross-sectional survey of patients in physician practices. Subjects came from adult primary care practices in western New York. A random sample of 100 primary care physicians and 50 consecutive patients seen by each physician participated in the study. Independent variables were census-derived (block group and zip code) patient SES and patient-reported education. The outcomes were physician ranks for patient satisfaction (Patient Satisfaction Questionnaire) and physical and mental health status (SF-12). RESULTS. In empirical Bayes models that adjusted for patient age, age squared, gender, insurance, and case mix, both the census-derived measures (block group and zip code) of SES and education had similar effects on each of the physician profiles. CONCLUSIONS. The results suggest that SES derived from either patient addresses geocoded to the census block group level or zip codes may offer a convenient alternative to individually collected SES when adjusting physician profiles for the socioeconomic characteristics of physicians' practices. The relative ease of using zip codes compared with geocoded addresses and loss of information associated with incomplete matching during geocoding suggest that zip code-derived SES may be preferable.

Management control and hospital cost reduction: additional evidence

We consider the consequences of the attempts of a particular hospital to control costs, through reductions in patients' length of stay (LOS), using management accounting control techniques, including physician profiling. Building on prior research discussed in our paper, that documents how profiling was more successful in reducing LOS but less successful in reducing cost, we demonstrate how the economic and social consequences of the profiling program were evaluated. Using data collected from a hospital as well as other data, we found that both LOS and the number of procedures performed per patient were significant determinants of monthly hospital costs, but the physician profiling policy was also found to be associated with a significant increase in the number of procedures performed per patient day. As a result, because the potential savings from fewer patient days appeared to have been offset by a concurrent increase in procedures performed per patient day, the profiling program did not produce a significant reduction in hospital costs.

The theory and methodology of provider profiling.

Physician profiling is the comparison of physician practice patterns to determine the existence and effects of significant differences in outcomes. To optimize care quality, these comparisons can be used to influence provider behavior through awareness when outcomes are poor or do not warrant provider expenditures. To maximize the value of such a technique, the underlying bases for comparison and the uses of derived data must be understood. Several factors must be considered or controlled for when determining comparable providers. Additionally, the worth or significance of findings must also be understood. This paper seeks to provide information in these two areas for the benefit of those responsible for managing care at all levels.

Paternalism, patient autonomy, and moral deliberation in the physician–patient relationship: Attitudes among Norwegian physicians

Sixteen statements on physician attitudes in the physician–patient relationship were presented to a representative sample of Norwegian physicians ( N=990). Three moderately correlated theoretical dimensions were identified in a principal component analysis: paternalism, patient autonomy, and moral deliberation. The paternalism scores increased significantly with age, and psychiatrists scored significantly lower than physicians in somatic specialties. Psychiatrists had the highest scores on the patient autonomy dimension, whereas surgeons scored the lowest. Moral deliberation scores increased slightly with age. To explore the pattern of scores across the three dimensions, the scores were dichotomized and combined in eight different ways. The resulting typology included five different physician profiles: (1) classical paternalists (high scores on paternalism, low scores on both patient autonomy and moral deliberation), (2) modern paternalists (high scores on both paternalism and deliberation, low scores on patient autonomy), (3) autonomists ( high scores on patient autonomy, low scores on both paternalism and deliberation), (4) deliberationists (high scores on deliberation and patient autonomy, low scores on paternalism), and (5) ambivalents (high or low scores on all dimensions, or high or low scores on both paternalism and patient autonomy). The four groups of physicians with ‘consistent’ attitudes contained between 12 and 19% of the total sample, whereas 37% belonged to the ‘ambivalent’ group. Laboratory doctors and surgeons belonged significantly more often in the group of classical paternalists than did general practitioners, whereas male physicians were more often modern paternalists than were female physicians. Among the autonomists, women were more numerous than men, doctors in their 40s clearly more numerous than those in their 60s, and psychiatrists clearly more numerous than residents.

Physician profiling: is it a reliable measure of quality of care?

Physician profiling: is it a reliable measure of quality of care?

The Unreliability of Individual Physician “Report Cards” for Assessing the Costs and Quality of Care of a Chronic Disease

HOFER, TIMOTHY P.; HAYWARD, RODNEY A.; GREENFIELD, SHELDON; WAGNER, EDWARD H.; KAPLAN, SHERRIE H.; MANNING, WILLARD G. Author Information

Physician Profiling and Risk Adjustment

Physician Profiling and Risk Adjustment

Physician profiling using data envelopment analysis: a case study

As an alternative to existing physician profiling methods, we used DEA to evaluate the efficiency of primary care physicians from a managed care organisation. Taking a case study approach, we discuss how data collected by this organisation regarding resource utilisation, cost, and quality can be used in various DEA models to determine physician efficiency. We consider several decisions regarding the selection of the DEA models and data to be used in these models. We introduce a guided stepwise method to determine a small, but relevant, set of input and output variables. Physicians were analysed on the basis of both in-patient and out-patient performance. DEA not only provided measures of physician efficiency, but also identified a small set of reference groups to serve as role models for non-efficient physicians.

Influence of patient education on profiles of physician practices.

Few data are available about the effect of patient socioeconomic status on profiles of physician practices. To determine the ways in which adjustment for patients' level of education (as a measure of socioeconomic status) changes profiles of physician practices. Cross-sectional survey of patients in physician practices. Managed care organization in western New York State. A random sample of 100 primary care physicians and 50 consecutive patients seen by each physician. Ranks of physicians for patient physical and mental health (Short Form 12-Item Health Survey) and satisfaction (Patient Satisfaction Questionnaire), adjusted for patient age, sex, morbidity, and education. Physicians whose patients had a lower mean level of education had significantly better ranks for patient physical and mental health status after adjustment for patients' level of education level than they did before adjustment (P < 0.001); this result was not seen for patient satisfaction. After adjustment for patients' level of education, each 1-year decrease in mean educational level was associated with a rank that improved by 8.1 (95% CI, 6.6 to 9.6) for patient physical health status and by 4.9 (CI, 3.9 to 5.9) for patient mental health status. Adjustment for education had similar effects for practices with more educated patients and those with less educated patients. Profiles of physician practices that base ratings of physician performance on patients' physical and mental health status are substantially affected by patients' level of education. However, these results do not suggest that physicians who care for less educated patients provide worse care. Physician profiling should account for differences in patients' level of education.

Pediatric Physician Profiling

This Policy Statement was retired May 2007. Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.

Addressing Physician Compensation and Practice Productivity

Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physician compensation method that supports the group's overall financial and organizational strategies, including managed care contracting strategies; is consistent with the philosophies, beliefs, and attitudes of the group's membership as they pertain to individual productivity; and can be supported by the organization's information technology, decision support, and management infrastructures. This article explains how research in physician profiling, benchmarking, general compensation theory, and physician productivity provides evidence that can serve as the foundation for a pragmatic approach to evaluating physician compensation method alternatives. It also presents a unique production-based compensation model for illustrative purposes.