A paper by Hofer et al. (JAMA 1999) looked at the reliability of physician report cards having to do with diabetes treatment. The authors looked at variability across physicians in the number of physician visits and hospitalizations among diabetic patients. They found:
- Other factors affect hospitalization more than physician care. “For profiles based on hospitalization rates, visit rates, laboratory utilization rates, and glycemic control, 4% or less of the overall variance was attributable to differences in physician practice…13% of the variation in outpatient visit rates and 8% of the variation for hospitalization rates are attributable to the physician”
- Physicians can game the system. If risk adjustment is not perfect–which it will never be–physicians could avoid being seen as high cost by pruning from their panel the 1 to 3 sickest patients.
- Physician profiling is expensive. Profiling ventures can add between $0.59 to $2.17 per member per month (in 1999 dollars).
- Timothy P. Hofer; Rodney A. Hayward; Sheldon Greenfield; Edward H. Wagner; Sherrie H. Kaplan; Willard G. Manning (1999) “The Unreliability of Individual Physician ‘Report Cards’ for Assessing the Costs and Quality of Care of a Chronic Disease” JAMA. 1999;281:2098-2105.