The validity and usage of resource utilization data among a group of primary care physicians

The use of individual resource utilization scores to compare primary care physicians (PCPs) has become more commonplace as managed care organizations (MCOs) increase their penetration into the US healthcare market. This study looks at the validity and usage of these scores among a group of PCPs within a multispecialty clinic that is part of an integrated managed care network. Personal interviews were conducted with PCPs; and reviews were done of the practice site paper charts, the computerized visit record system of the clinic and affiliated hospital, and the MCO-supplied resource utilization data on the 25 patients of each PCP on whom the most healthcare dollars were spent in 1995. As of October 1996, few PCPs had done more than a cursory review of their resource utilization data. None had identified the patients who use the most resources or developed any methods to proactively manage those patients with a history of high utilization. The clinic's communication systems alerted the PCPs less than 50% of the time when patients for whom they were responsible had high utilization of services. Patients appeared to be assigned to the incorrect PCP more than 20% of the time. All players in this managed care network--PCPs, clinic administration, and the MCO--must work together to improve the current system before resource utilization data are considered valid and are incorporated more fully into clinical practice.