Measuring physician performance alone won't lower costs, HSC study says

A study released by the Center for Studying Health System Change suggests that early efforts to measure physician performance without addressing certain methodological and other shortcomings may not help lower healthcare costs..

Although the United States spends more than $2 trillion annually on healthcare, patient outcomes lag behind those in other developed countries that spend far less per capita, according to Debra A. Draper,  a senior fellow at HSC.

"The disconnect between money spent on healthcare and the often less-than-stellar results has sparked national awareness of the critical importance of measuring and improving healthcare quality and slowing spending growth through increased efficiency," Draper said. "As a result, nascent efforts are underway to measure and improve physician performance on both quality and cost dimensions."

According to HSC,  most performance measurement programs have been developed by health plans and operate under a variety of names, such as the Aexcel Specialist Network (Aetna), Blue Precision (Blue Cross Blue Shield), Care Network (CIGNA), Preferred Network (Humana) and Premium Designation Program (UnitedHealthcare).

Typically, health plans use the results only to inform consumers. In some cases, consumers have incentives, such as reduced copayments, to use higher-performing physicians. Plans rarely pay bonuses to physicians deemed high performing. Quality and efficiency improvements are achieved when patients shift to higher-performing physicians, motivating lower-performing physicians to improve the care they provide.

Although plans' programs are broadly similar, their methodologies often differ on such dimensions as the specific measures used, sample-size requirements and the comparative emphasis placed on quality vs. cost measures, according to Draper. Comparing individual plan results is difficult, and physicians can be deemed high performing by one plan but not another.

"Measuring performance is an important and necessary initial step to improving the quality and efficiency of care provided, but measurement alone is likely insufficient to prompt physicians to improve performance," Draper said. "Support to improve performance and rewards to encourage and reinforce desired behaviors also are needed. However, these elements are largely absent from many health plan efforts, and when they do exist, they are inadequate to bring about meaningful or sustained performance improvement."

According to the study, key challenges to effective physician performance measurement include:

  • Developing a consensus on what standards should guide physician performance measurement programs.

  • Measuring physicians across the entire patient panel, rathet than on a piecemeal basis, with individual plans focusing only on their respective subset of patients. However, combining data from all payers, including Medicare and Medicaid, to conduct an accurate assessment will likely require a mandate from the federal government.

  • The absence of a convening entity with the necessary capacity, wherewithal and clout to neutralize existing competitive dynamics and champion physician performance measurement.

  • Supporting physicians willing to improve and providing robust rewards for physicians demonstrating good results.