Comparing Methods for Attributing Hospital Quality Metrics to Individual Physicians: Impact on Performance Assessment...

Area of Science:

• Healthcare quality measurement
• Value-based healthcare analytics
• Physician performance assessment

Background:

• Physician-attributed quality metrics are crucial for value-based healthcare and reimbursement.
• Team-based care delivery complicates accurate individual physician quality measurement.
• Lack of gold standards for physician attribution hinders accuracy.

Purpose of the Study:

• To compare the impact of different physician attribution methods on patient encounter inclusion.
• To analyze how attribution methods affect physician quality rankings and outlier identification.

Main Methods:

• Retrospective comparative analysis of 95,112 hospitalist encounters (Jan 2020-Sep 2024).
• Comparison of five attribution methods: Standard, Intermountain Method for Physician Attributed Quality (IMPAQ), Partial, Majority, and Plurality.
• Outcomes assessed: encounter inclusion/exclusion agreement, physician quartile rankings, and outlier identification for length of stay (LOS).

Main Results:

• Encounter attribution proportions varied by method (78%-100%).
• Majority and Plurality methods showed high agreement but skewed LOS encounter retention.
• IMPAQ and Standard methods had moderate agreement; IMPAQ identified more extreme physician outliers.
• Physician rankings shifted significantly (up to 5 standard deviations) across methods.

Conclusions:

• Attribution method significantly influences encounter inclusion and hospitalist performance assessment.
• Methods retaining encounters without meaningful oversight may obscure true physician performance.
• Consensus on attribution methodologies is urgently needed for valid performance assessment in team-based care.