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Benchmarking medical group practices using claims data: methodological and practical problems.

H G Dove1, B R Greene

  • 1Department of Health Policy and Administration, Yale University, New Haven, Connecticut, USA.

The Journal of Ambulatory Care Management
|November 7, 2000
PubMed
Summary
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Health information vendors face limitations with physician claims data, impacting benchmarking. Future improvements may come from electronic health records and the internet, enhancing data quality for medical groups.

Area of Science:

  • Health Informatics
  • Health Services Research

Background:

  • Health information vendors are increasingly marketing data on medical group productivity, utilization, and quality.
  • Physician claims data quality and quantity have improved, driving this market trend.

Purpose of the Study:

  • To identify methodological and practical issues in health information vendor products.
  • To assess the current limitations and future potential of benchmarking data for medical groups.

Main Methods:

  • Analysis of product evolution based on interviews with health information product developers.
  • Evaluation of common data shortcomings in physicians' claims data.

Main Results:

  • Current physician claims data have significant limitations, including inadequate enrollment figures and potential coding inaccuracies (upcoding, incorrect disease-ruling-out codes).

Related Experiment Videos

  • The market for benchmarking products for group practices is immature but shows promise.

    • Conclusions:

    • Health information vendors and purchasers must acknowledge current data limitations.
    • Future advancements in computer-based medical records and internet technologies are expected to improve data richness and quality for medical groups.
    • Benchmarking data is crucial for provider organizations managing medical risk and for non-provider organizations involved in product planning and physician negotiation.