Association Between Quality of Care and the Sociodemographic Composition of Physicians’ Patient Panels: A Repeat Cross-Sectional Analysis

Abstract

BACKGROUND: Pay-for-performance programs could worsen health disparities if providers who care for disadvantaged patients face systematic barriers to providing high-quality care. Risk Medicare claims data and the association between quality and the sociodemographic composition of physicians' patient panels. KEY RESULTS: Across eight quality measures, physicians' quality of care was not consistently associated with the composition of their patient panel either in a single year or between time periods. For example, a substantial number (seven) of the eighteen significant associations seen between sociodemographic characteristics and the delivery of preventive services in the first time period were no longer seen in the second time period. Among sociodemographic characteristics, panel Medicaid eligibility was most consistently associated with differences in the delivery of preventive services between time points; among preventive services, the delivery of influenza vaccine was most likely to demonstrate disparities in both time points. CONCLUSIONS: In a Medicare pay-for-performance program, a better understanding of the effect of effect of patient panel composition on physicians' quality of care may be necessary before implementing routine statistical adjustment, since the association of quality and sociodemographic composition is small and inconsistent. In addition, we observed improvements between time periods among physicians with varying panel composition.KEY WORDS: quality; disparities; payment incentives. J Gen Intern Med 26(9):987-94

Refining Physician Quality Indicators for Screening Mammography in Older Women: Distinguishing Appropriate Use from Overuse

“…1, 2 However, cancer screening in patients with limited life expectancy is unlikely to prevent death from cancer, and is quite likely to lead to unnecessary diagnoses and treatments in patients who otherwise would have died before the cancer became clinically apparent. 3–5 For example, randomized trials of mammography did not find a reduction in breast cancer mortality before seven years follow-up in women aged 65–75.…”

Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers

“…We have also found evidence to suggest that PCP access and more severe symptomatology may partially explain the disproportionate ED use for ARS by patients with Medicaid and self‐pay insurance statuses, respectively . Other studies have shown patients' preferences for the ED for management of ACSCs to arise in some cases from the belief that their concerns will be taken more seriously, or that they will be treated more urgently or with greater ease of testing and management with medications . It is possible that patients appreciate differential treatment if they present to a PCP versus ED in terms of likelihood of receiving an antibiotic prescription.…”

“…5,6 Other studies have shown patients' preferences for the ED for management of ACSCs to arise in some cases from the belief that their concerns will be taken more seriously, or that they will be treated more urgently or with greater ease of testing and management with medications. 7 It is possible that patients appreciate differential treatment if they present to a PCP versus ED in terms of likelihood of receiving an antibiotic prescription. In this study, we seek to characterize and compare antibiotic prescribing behavior in the primary care setting and in EDs for uncomplicated ARS.…”

Association Between Emergency Physician Length of Stay Rankings and Patient Characteristics

“…Indeed, a number of prior studies in various clinical settings found close association between performance metrics and patient panel characteristics, and that not accounting for case mix could incorrectly identify outliers and mischaracterize practice variation. [37][38][39][40][41][42][43] Given the expanding role of interventions that aim to reduce variation through physician metrics, poorly reflective metrics may not only mislead efforts toward improving clinical practice and accountability but also exacerbate burnout. [44][45][46][47][48][49] Further investigations to determine how to best account for physician choice and case mix are needed, [50][51][52] but our results suggest that unadjusted LOS, in the absence of counterbalancing measures such as relative value units, is an unstable metric for comparing emergency physician performance with practice groups and that its use should be carefully reconsidered.…”