Global measures commonly used to measure the efficiency of physician practices may actually hinder efforts to reduce the overuse and misuse of health care services, according to a Commonwealth Fund-supported study published today as a Health Affairs Web Exclusive.
Drs. Greene, Beckman, and Mahoney tested their approach at the 3,400-physician Rochester Individual Practice Association (RIPA) to determine better-quality care in treating hypertension and using fiberoptic laryngoscopy to evaluate problems with swallowing. Rather than relying on the "efficiency index"—a fairly crude measure of provider cost efficiency that focuses on global cost control—their approach seeks to identify specific overused and underused procedures and then encourage practitioners to make changes. In essence, the researchers asked the question, 'What are lower-cost and higher-cost physicians doing differently from each other?'
In the case of throat disorders, the main cost driver at RIPA was the performance of fiberoptic laryngoscopies. Physicians in the highest-spending quartile performed 3.4 times more procedures than their counterparts in the lowest-spending quartile. But greater use of the procedure was not associated with better outcomes, and physicians who performed more laryngoscopies had relatively higher costs for office visits and pharmaceuticals.
Many heavy users of fiberoptic laryngoscopy were genuinely surprised when RIPA staff showed them that they used the procedure more than other physicians. By respectfully meeting with the doctors to share the results, RIPA was able to reduce the rate of fiberoptic laryngoscopies by 17 percent in 2006 compared with 2005.
