Economic profiling of primary care physicians: consistency among risk-adjusted measures

Health Services Research
J William ThomasKathleen Ward

Abstract

To investigate whether different risk-adjustment methodologies and economic profiling or "practice efficiency" metrics produce differences in practice efficiency rankings for a set of primary care physicians (PCPs). Twelve months of claims records (inpatient, outpatient, professional, and pharmacy) for an independent practice association HMO. Patient risk scores obtained with six profiling risk-adjustment methodologies were used in conjunction with claims cost tabulations to measure practice efficiency of all primary care physicians who managed 25 or more members of an HMO. For each of the risk-adjustment methodologies, two measures of "efficiency" were constructed: the standardized cost difference between total observed (standardized actual) and total expected costs for patients managed by each PCP, and the ratio of the PCP's total observed to total expected costs (O/E ratio). Primary care physicians were ranked from most to least efficient according to each risk-adjusted measure, and level of agreement among measures was tested using weighted kappa. Separate rankings were constructed for pediatricians and for other primary care physicians. Moderate to high levels of agreement were observed among the six risk-adjusted measures...Continue Reading

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Citations

Sep 24, 2013·International Journal of Health Care Finance and Economics·Song ChenAneesh Nandam
Nov 24, 2006·Medical Care·Bonnie K LindDavid E Grembowski
Apr 25, 2012·Medical Care·Arlene S Ash, Randall P Ellis
Mar 9, 2010·BMC Health Services Research·John L AdamsAteev Mehrotra
Feb 4, 2009·Health Services Research·Peter S HusseyElizabeth A McGlynn
Apr 25, 2012·Health Services Research·Brent A Metfessel, Robert A Greene
Apr 4, 2007·Neonatal Network : NN·Lina Kurdahi BadrMirvat Hawari
Jan 21, 2017·BMC Health Services Research·Karl FinisonDaniel Gottlieb
Aug 8, 2013·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Frank Eijkenaar, René C J A van Vliet
Oct 21, 2009·Evaluation Review·John Robst
May 5, 2010·Health Affairs·Katie Merrell, Robert A Berenson

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