Academic journal article Journal of Healthcare Management

Composite Model for Profiling Physicians across Domains of Care/PRACTITIONER APPLICATION

Academic journal article Journal of Healthcare Management

Composite Model for Profiling Physicians across Domains of Care/PRACTITIONER APPLICATION

Article excerpt

Lori R. Pelletier, PhD, associate vice president, UMass Memorial Health Care, and assistant professor, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Sharon A. Johnson, PhD, associate professor, Operations and Industrial Engineering, Worcester Polytechnic Institute School of Business, Worcester; Edward R. Westrick, MD, president of Medical Affairs, medical director, and primary care physician, PACE Organization of Rhode Island, Providence; Elaine R. Fontaine, director, Data Quality and Analytics, Rhode Island Quality Institute, Providence; Alan D. Krinsky, PhD, senior data analyst, Office of Clinical Integration, UMass Memorial Health Care; Robert A. Klugman, MD, vice president, Medical Affairs, Eastern Region, Kindred Healthcare, Andover, Massachusetts; and Arlene S. Ash, PhD, professor, Quantitative Health Sciences, University of Massachusetts Medical School

EXECUTIVE SUMMARY

Physician profiling methods are envisioned as a means of promoting healthcare quality by recognizing the contributions of individual physicians. Developing methods that can reliably distinguish among physicians' performance is challenging because of small sample sizes, incomplete data, and physician panel differences. In this study, we developed a hierarchical, weighted composite model to reliably compare primary care physicians across domains of care, and we demonstrated its use within a clinical system.

We evaluated 199 primary care physicians from a large integrated healthcare delivery system using 19 quality and two efficiency measures taken from the Healthcare Effectiveness Data and Information Set and existing pay-for-performance programs. Individual measures were calculated, compared to benchmarks, and grouped into two composites: one focused on quality and one on efficiency. Each composite was fitted to the model, assessed for reliability (signal-to-noise ratio), and weighted to create a single summary score for each primary care physician. The quality-of-care composite had a median reliability of .98, with 99.5% of all physician reliability estimates exceeding threshold. The efficiency composite had a median reliability of .97, with 94.9% of all physician reliability estimates exceeding threshold.

Our results demonstrate that reliable physician profiling is possible across care domains using a hierarchical composite model based on multiple data. The model was used to distribute incentive payouts among primary care physicians but is adaptable to many settings.

For more information about the concepts in this article, contact Dr. Pelletier at lori.pelletier@umassmemorial.org.

INTRODUCTION

Physician profiling has been recognized as potentially valuable in healthcare reform by U.S. policy makers and commercial purchasers, who cope with the world's highest healthcare expenditures (KFF, 2009). Physician profiling requires models or methods for scoring the care that physicians have delivered to their patient panels, usually based on several individual, program-specific quality measures. Health plans use profiling extensively in pay-for-performance (P4P) programs to determine performance targets for contract negotiations and to generate financial incentives at physician and organizational levels. Performance feedback and incentives are intended to guide physicians to deliver high-quality, efficient care (Wodchis, Ross, & Detsky, 2007; Lexa, 2008) as well as to derive insights about the care delivery system.

When P4P programs are driven by health plans, physician groups may be unaware of specific model variables, such as case-mix adjustments and weighting schemes, which vary by health plan. In addition, healthcare organizations may need to manage the sometimes conflicting reports across health plans (Draper, 2009). While some healthcare organizations have developed their own performance tools, such as balanced scorecards (Curtright, StolpSmith, & Edell, 2000; Impagliazzo, Ippolito, & Zoccoli, 2009; Stewart & Greisler, 2002), no standard approach exists to evaluate measures across domains of care, practice functionality, and patient experience that allows for broader profiling of individual clinicians. …

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