Physicians Identify New Ways to Reduce Overuse and Increase Efficiency

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<p>Global measures commonly used to measure the efficiency of physician practices may actually hinder efforts to reduce the overuse of health care services, according to a <a href="/publications/in-the-literature/2008/may/beyond-the-efficiency-index--finding-a-better-way-to-reduce-overuse-and-increase-efficiency-in-physi
">Commonwealth Fund-supported study</a> published today as a <em>Health Affairs</em> Web Exclusive.<br><br>Finding that "much variation in clinical practice is attributable to physician preference, habit, and training, rather than patient preference, severity, or outcomes," authors Robert A. Greene, M.D., Howard B. Beckman, M.D., and Thomas Mahoney, M.D., suggest an alternative approach to measuring efficiency that aims to identify wasteful practices and engage physicians to change their behaviors. Rather than relying on the "efficiency index"--a measure of provider cost efficiency that fails to identify "action items" for evaluated physicians and often includes high-cost events not under their control--the researchers instead asked the question, 'What are lower-cost and higher-cost physicians doing differently from each other?'<br><br>Drs. Greene, Beckman, and Mahoney developed their approach based on their experience with the 3,400-physician Rochester Individual Practice Association. In applying the new method to hypertension care, the researchers found that pharmacy costs varied more than five times as much as lab test or office visit costs, signaling that medication choice was the major driver of cost variation.<br><br>"Given inevitable limits of time and energy, it is important to focus quality improvement efforts on the true drivers of unnecessary cost and variations and to generate preferred practice patterns for entire specialties rather than individual physicians," the authors conclude.</p>