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Do report cards score with patients and doctors?
Insights
Physician report cards for diabetes care did not reliably show practice differences due to small patient numbers. This method may discourage doctors from treating complex or costly patients.
Area of Science:
- Health Services Research
- Medical Quality Improvement
- Diabetes Care Management
Background:
- Physician profiling, using report cards, is a strategy to assess and improve healthcare quality.
- Evaluating physician performance based on patient outcomes is complex and faces methodological challenges.
Purpose of the Study:
- To assess the reliability of physician report cards in detecting practice variations for diabetes care.
- To identify limitations in using patient outcomes for evaluating physician performance.
Main Methods:
- The study analyzed data from a U.S. Agency for Health Care Policy and Research-sponsored project.
- Physician performance was evaluated using report cards focusing on diabetes patient outcomes across different practice types.
Main Results:
- Physician report cards for diabetes care were unreliable in distinguishing true practice differences among physicians.
- The limited number of diabetic patients managed by individual physicians was a significant factor in the lack of reliable outcome detection.
- Profiling methods may create incentives for physicians to avoid patients with complex or high-cost conditions.
Conclusions:
- Current physician profiling methods for diabetes care may not accurately reflect physician practice variations.
- The small patient populations in many practices limit the effectiveness of outcome-based physician evaluations.
- Physician profiling linked to incentives could negatively impact care for patients with challenging health conditions.
Abstract:
Key points. A study sponsored by U.S. Agency for Health Care Policy and Research showed that physician report cards (physician profiles) for diabetes were unable to reliably detect true practice differences among doctors at three types of medical practices studied. The difficulty in using outcomes to evaluate physician performance in this study was due, in large part, to the relatively small number of diabetics managed by each doctor. A major problem with the current method of profiling individual doctors is the process can backfire if linked to powerful incentives not to have patients whose conditions are hard to manage and/or incur high costs.