Unbiased Analysis of Today's Healthcare Issues
Avedis Donabedian has a revealing article regarding how to assess quality in the medical profession. His 1988 JAMA and 2005 Milbank Quarterly articles include the following important points: Physician quality is not only technical. Interpersonal skills are also important. The patient must communicate information to the physician and the physician must provide information to the…
How does one evaluate a physician’s efficiency level? This process has five main dimensions. Which resource use measurement methodology to use. There are two main profiling methodologies: per capita and episode-based. How to account for differences in patient health status. This is done through risk adjustment. However, choosing the proper risk adjustment method is crucial…
Pay-for-performance is a hot topic in the health policy world. However, one of the largest pay-for-performance programs has already been implemented in the UK’s National Health Service. A paper by Doran et al. (2006) reviews the overall implementation of the NHS’s P4P program as well as how some physicians used exceptions to greatly increase their…
Pay-for-performance has become very fashionable of late. One way to measure physician performance is with episode groupers. This software groups together some or all of the services related to the care of a patient’s chronic or acute medical conditions. Policymakers can then use the episode as the unit of observation for: feedback on physician performance,…
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…
Episodes of care are defined as the bundle of medical treatments used to treat an illness over a specified time period. Because all treatments are bundled together, these episodes have been thought to provide a superior unit of analysis in pay-for-performance (P4P) systems. In fact, Oxford Health Plan pioneered episode payment in the 1990s. [Later,…
One laudable goal is to improve medical quality while reducing cost. One way members of Congress have proposed to accomplish this is to use episode groupers in order to provide feedback to doctors regarding their resource use. None other than Max Baucus has advocated this (see p. 45 of this white paper). However, matching patient…
According to Eisenberg (Medical Care 2002): “Although physicians’ professional fees represent only one fifth of health care expenditures, they are responsible far decisions that govern the way that as much as 90% of each health care dollar is used.” One way to change behavior is to give physician feedback. Here’s how to do it right:…