Provider profiling -- used by health plans and purchasing groups to evaluate physicians on just about everything these days -- is expensive, unreliable and doesn't accurately measure anything, a new study contends.
"It's distracting at best and can be much worse," says Timothy Hofer, M.D., one of six co-authors of the study published last month in the Journal of the American Medical Association. Hofer is an internist with the Veterans Affairs Center for Practice Management and Outcomes Research at the University of Michigan. In fact, Hofer says, because a bad report card could lead health plans to drop physicians, doctors may have incentives not to see sicker patients.
Health plans typically use provider profiling for internal review purposes, while report cards help patients select the best physician.
Hofer and colleagues set out to determine the reliability of physician profiling by studying 3,642 diabetes patients in a variety of practice settings in three geographic locations. The study evaluated patients' hospitalization and clinic visit rates, total laboratory resource utilization rate and level of glycemia control.
After the researchers adjusted for such factors as socioeconomic status, duration of diabetes and health status, they found that one physician has no more influence on patient outcomes than another. In fact, physician influence accounts for only 4% of the patients' outcomes. Yet profiling can cost 59 cents to $2.17 per member/per month, according to the authors.
"Although we found some differences between our three sites that were not attributable to case-mix differences, relatively little of the variation in any of the resource utilization or glycemia control measures evaluated was due to individual physician practice style," the authors wrote in the June 9 issue ofJAMA.
"Once you adjust for everything else, there's not much variation left (per) provider, which means maybe you don't need to spend a lot of time looking at provider information," Hofer says.
Lee Newcomer, M.D., senior vice president of Minneapolis-based managed-care company UnitedHealth Group, says the study should not discourage people from profiling.
"The kind of profiling we do is looking at processes, and we've always said its intention was not to deselect physicians. Instead, we've been sending physicians information about how they practice," he says. "The fear about (an article like this) is people will read it and say we shouldn't do any measurement at all.
Instead, I think we should do even more and think about quality improvement processes."
The Pacific Business Group on Health, a San Francisco-based employer healthcare purchasing coalition, regularly publishes report cards on HMOs, hospitals and physician groups. But Tama Donaldson, PBGH manager, says the group doesn't issue report cards on individual physicians.
"Because of the relatively small number of patients at the individual physician level, we suppose it might be difficult to obtain statistically valid data in order to generate reliable report cards," she says. "We generate physician group report cards in order to give consumers the information they need to make informed choices about their own healthcare. At PBGH, we believe that the healthcare consumer can set expectations for what constitutes a high-end product."