Small clinical cost studies can improve physician practice patterns

The Exempla Lutheran Medical Center uses the analysis of individual physician practice patterns to improve physician performance. Studies of initial breast biopsies, inguinal herniorrhaphy, laparoscopic cholecystectomy, and anterior cruciate ligament repair provided quantitative clinical information for analyzing individual practice patterns. The breast biopsy study indicated a positive correlation between practice patterns and patient satisfaction. Results from the inguinal herniorrhaphy study led to cost reductions due to increased information on supply cost. Despite the documented similarity in practice patterns for laparoscopic cholecystectomy, cost data analysis revealed differences of more than $1,000 per case for one physician. Further investigation showed that variance in profit margins was due to differing reimbursements from insurance contracts. All three studies demonstrated that cost data can stimulate discussion among providers and influence individual practice patterns.