Physician Performance

Only a fraction of the wide variety of services individual physicians and physician groups typically perform can be clearly linked to measurable outcomes that reflect quality of care. Current approaches to performance measurement generally focus on physician groups rather than individual physicians and measure not outcomes but processes, such as whether the services that are provided accord with agreed-upon norms. Several private and public organizations in California, New York, and Pennsylvania have developed report cards that provide information closer to the level of the individual physician than health plan report cards do, although they do not always help consumers make informed choices about physicians. The accuracy and completeness of the report card data and the adequacy of the risk adjustment methodologies also limit consumers' and physicians' confidence in them. Several national accreditation organizations as well as the Department of Health and Human Services are working on developing common performance measures and on establishing standards for administrative claims and encounter data.

GAO noted that: (1) measuring performance in health care is challenging in terms of identifying measures that truly reflect the quality of care individuals receive; (2) it is also difficult to make comparisons across plans or providers that account for differences in the patients whom they treat that can affect health care outcomes; (3) measuring the performance of physician groups and individual physicians is even more difficult; (4) individual physicians or groups perform a wide variety of services and typically perform any individual service for a small number of patients; (5) only a fraction of these services can be clearly linked to a measurable outcome; (6) to make meaningful comparisons among physicians, analysts must adjust any measure selected to take into consideration the extent to which a characteristic like the severity of a medical condition affects the outcomes from care; (7) to avoid these difficulties, approaches to performance measurement generally focus on physician groups instead of individual physicians, and they measure processes such as whether services are provided in accordance with agreed upon norms rather than outcomes of care; (8) adding to the challenges, however, are concerns that consumers have regarding the privacy of their personal medical information and that physicians have regarding the accuracy of performance measurement data; (9) even though the data and measures that are available are limited, several different private and public organizations have developed physician and physician group report cards using these data and measures; (10) in New York and Pennsylvania, state agencies that have reported on the performance of individual cardiac surgeons since the early 1990s have reported improved performance scores since they began publishing them; (11) while significant, these efforts at physician report cards are in their early stages or are limited in scope, and difficulties remain; (12) some organizations are collaborating to develop more comprehensive, standardized performance measures and to facilitate the exchange of clinical and administrative data between physicians, plans, and purchasers; and (13) at the federal level, the Department of Health and Human Services is working on a performance measurement system for its Medicare fee-for-service program and has been supporting research and working with other organizations to develop physician performance measures.