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Performance measurement in the small office practice: challenges and potential solutions.

Bruce E Landon1, Sharon-Lise T Normand

  • 1Harvard Medical School, Beth Israel Deaconess Medical Center, and Harvard School of Public Health, Boston, Massachusetts 02115, USA. Landon@hcp.med.harvard.edu

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Summary

Measuring physician performance is challenging for small practices due to limited resources and infrastructure. Solutions are proposed to ensure these small practices are included in quality improvement programs.

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Area of Science:

  • Health Services Research
  • Quality Improvement
  • Healthcare Policy

Background:

  • Healthcare quality and safety programs are advancing, with measurement systems in ambulatory settings for public reporting and pay-for-performance.
  • Physician practice in the U.S. is diverse, with many solo or small group practices, posing unique measurement challenges.

Purpose of the Study:

  • To review the U.S. physician practice landscape.
  • To describe performance measurement challenges in small practice settings.
  • To propose solutions for including small practices in performance assessment programs.

Main Methods:

  • Review of the U.S. physician practice landscape.
  • Analysis of performance measurement challenges specific to small practices (financial, staffing, infrastructure, health IT).
  • Discussion of statistical issues impacting quality assessment for small practices.

Main Results:

  • Small practices face significant hurdles in performance measurement, including lack of infrastructure, health information technology, support staff, and increased burden.
  • Assessing quality in small practices is complicated by a smaller patient volume across multiple payers.
  • Recommendations for system design, measure selection, and interventions are presented to facilitate small practice inclusion.

Conclusions:

  • A substantial proportion of U.S. physicians practice in small settings, necessitating their inclusion in performance measurement programs.
  • Policies and programs for physician performance measurement must incorporate features that support and include small practices.
  • Addressing the unique challenges of small practices is crucial for equitable and comprehensive healthcare quality assessment.