Grading a Physician's Value — The Misapplication of Performance Measurement

Berenson, Robert A.; Kaye, Deborah R.

doi:10.1056/nejmp1312287

Cited by 56 publications

(59 citation statements)

References 4 publications

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“…Given physicians' role in the health care delivery system, understanding their experiences, attitudes, and behaviors is enormously important for evaluating the success of these public and private efforts. 1 However, the reliability of existing sampling frames can present a challenge to ensuring representativeness and decreasing bias in physician surveys.…”

Section: Introductionmentioning

confidence: 99%

The Results Are Only as Good as the Sample: Assessing Three National Physician Sampling Frames

et al. 2015

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BACKGROUND: Databases of practicing physicians are important for studies that require sampling physicians or counting the physician population in a given area. However, little is known about how the three main sampling frames differ from each other. OBJECTIVE: Our purpose was to compare the National Provider and Plan Enumeration System (NPPES), the American Medical Association Masterfile and the SK&A physician file. METHODS: We randomly sampled 3000 physicians from the NPPES (500 in six specialties). We conducted two-and three-way comparisons across three databases to determine the extent to which they matched on address and specialty. In addition, we randomly selected 1200 physicians (200 per specialty) for telephone verification. KEY RESULTS: One thousand, six hundred and fiftyfive physicians (55 %) were found in all three data files. The SK&A data file had the highest rate of missing physicians when compared to the NPPES, and varied by specialty (50 % in radiology vs. 28 % in cardiology). NPPES and SK&A had the highest rates of matching mailing address information, while the AMA Masterfile had low rates compared with the NPPES. We were able to confirm 65 % of physicians' address information by phone. The NPPES and SK&A had similar rates of correct address information in phone verification (72-94 % and 79-92 %, respectively, across specialties), while the AMA Masterfile had significantly lower rates of correct address information across all specialties (32-54 % across specialties). CONCLUSIONS: None of the data files in this study were perfect; the fact that we were unable to reach one-third of our telephone verification sample is troubling. However, the study offers some encouragement for researchers conducting physician surveys. The NPPES and to a lesser extent, the SK&A file, appear to provide reasonably accurate, up-to-date address information for physicians billing public and provider insurers.

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Section: Introductionmentioning

confidence: 99%

The Results Are Only as Good as the Sample: Assessing Three National Physician Sampling Frames

et al. 2015

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“…[2][3][4][5][6] Physicians and hospitals have challenged these assumptions while also expressing concerns about the high cost of implementing quality measurement. [7][8][9][10][11][12][13] Foremost among their concerns is the inability of most outcomes studies to prove causal relationships between the care a patient receives and the outcome of that care, as quality studies rarely use random assignment of patients. Attempts to adjust quality measurements based on case mix complexity and social confounders have not resolved this controversy.…”

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confidence: 99%

“…18 But value measurement cannot work unless accurate and actionable quality measurement can be achieved, and this goal has not yet been attained. [11][12][13] So health policy leaders and health care professionals continue to struggle with a widening gap between the promise of quality improvement and value measurement, and the reality of their limitations. Of more concern to physicians is growing interest in measuring outcomes as an attribute of individual physician performance because of the effect this might have on their professional reputations.…”

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confidence: 99%

Measuring Outcomes: Lessons From the World of Public Education

Saultz

2017

Ann Fam Med

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The quality and efficiency of American health care are increasingly measured using clinical and financial data with a goal of improving clinical practice. Proponents believe such efforts can improve outcomes, motivate clinicians, and inform the public about quality. Detractors point to problems with the accuracy of these measures and the risk of creating perverse incentives for both physicians and patients. Drawing on lessons from similar performance management policies in public education, we provide guidance about this trend for primary care physicians and health care policy makers. We argue that public school teacher evaluations that use value-added modeling foretell specific pitfalls for the use of similar models to evaluate physician effectiveness, and that unintended consequences of performance management in both education and health care can include the narrowing of purpose, deprofessionalization, and a loss of local/community control. INTRODUCTIONF or much of the 20th century, the quality of medical care was considered to be an attribute of the person providing the care. Individuals seeking the best care looked for physicians who were board certified, trained in prestigious institutions, and recommended by friends or family members, or some combination thereof. Over the last 2 decades, this concept has eroded in the face of growing evidence of systemic problems with poor quality and uncontrollable costs in American health care.1 Today, as new information technology facilitates electronic data collection, the paradigm of quality as a clinician attribute is being replaced by systems of objective quality measurement and reporting. The notion of determining health care quality by measuring outcomes is based on 3 assumptions: that quality can be accurately measured, that quality can be improved, and that reporting quality measurement data will influence how people use health care and how clinicians practice.2-6 Physicians and hospitals have challenged these assumptions while also expressing concerns about the high cost of implementing quality measurement. [7][8][9][10][11][12][13] Foremost among their concerns is the inability of most outcomes studies to prove causal relationships between the care a patient receives and the outcome of that care, as quality studies rarely use random assignment of patients. Attempts to adjust quality measurements based on case mix complexity and social confounders have not resolved this controversy. In addition, data used to measure quality have generally come from electronic claims and patient satisfaction surveys, and, more recently, from data abstracted from electronic health records. All 3 sources of data have their limitations.Meanwhile, the policy community including health purchasers and health plans has begun to focus on measurement of value. [14][15][16] In this context, value is defined as the health outcomes achieved per dollar spent and potentially represents a way to prioritize health care services. 17Value measurement is a tempting policy target as the he...

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“…The relative weakness of the quality part of the determination of value is evident in the Valued-Based Payment Modifier program. As Berenson and Kaye 4 have pointed out,theperformancemeasurescaptureanarrow,misleading picture of overall performance for any given physician and do not correlate with broader efforts to improve quality. 5 Worse, reimbursing physicians based on performancemeasurescancausedetrimentaldistortionsincare, such as inordinate attention to the measures, the neglect of other important aspects of care, or the avoidance of sicker, poorer patients.…”

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confidence: 99%

The Argument Against Reimbursing Physicians for Value

Goitein

2014

JAMA Intern Med

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Grading a Physician's Value — The Misapplication of Performance Measurement

Cited by 56 publications

References 4 publications

The Results Are Only as Good as the Sample: Assessing Three National Physician Sampling Frames

The Results Are Only as Good as the Sample: Assessing Three National Physician Sampling Frames

Measuring Outcomes: Lessons From the World of Public Education

The Argument Against Reimbursing Physicians for Value

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