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Can We Get More Out of Physician Performance Measures?

Janice Simmons, for HealthLeaders Media, June 9, 2009

Efforts to measure and improve physician performances nationwide have gained momentum--particularly as a way to encourage consumers to be more active participants in their health and healthcare decisions. However, more needs to be done to build on these efforts to improve quality care and to recognize those physicians who provide that care, according to a new commentary published by the Center for Studying Health System Change.

For the most part, health plans have marketed physician performance in the form of physician-ranking programs or some type of tiered or high performance provider networks, said author Debra Draper, PhD, a senior fellow at the HSC. Nationwide, these programs operate under a variety of names, such as the Aexcel Specialist Network (Aetna), Blue Precision (Blue Cross Blue Shield), Care Network (CIGNA), Preferred Network (Humana), and Premium Designation Program (UnitedHealthcare).

The idea of these initiatives is to provide "a systematic and objective method of measuring physician performance" that use plans' claims or other administrative data, Draper said.

However, the results often are only used to inform consumers or, in some cases, give consumers incentives (such as reduced copayments) to use higher performing physicians. "Plans rarely pay bonuses to physicians they deem high performing," she said.

Also, while most physician performance measurement programs may seem similar, they vary in their methodologies, Draper said. The methodologies often can differ on the specific measures used, sample size requirements, and the comparative emphasis placed on quality vs. cost measures.

"Consequently, gauging the comparability of individual plan results is difficult because the decision algorithm each plan uses to conduct the assessments is proprietary with little--if any--transparency," she said.

Sometimes, this variability in performance measurement data can result in some physicians being deemed high-performing in one plan but not another, as was the case, for example, of one large integrated delivery system in Seattle.

Although most plans typically require a minimum sample size to assess a physician's performance, these thresholds tend to be set relatively low (e.g., fewer than a dozen patients). This is related in part to limitations associated with an individual plan's use of only their own claims data to conduct the assessment.

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