Physician rating data not in line with reality

According to a pair of new studies on various measures of physician performance, doctors' scores may have less to do with the quality of care they provide and be more closely linked to the traits of their patients.

First, a Massachusetts study reported in the September 8 issue of the Journal of the American Medical Association found patient characteristics such as race and insurance coverage had a large influence on how well physicians scored on report cards, such as those based on Health Plan Employer and Data Information Set (HEDIS) measures. Specifically, hospitals and community centers the researchers ranked in the highest-quality tier had fewer patients who belonged to ethnic minorities, were uninsured or relied on Medicaid.

The patients the top-ranking facilities did treat, on the other hand, earned more on average and were older and sicker, making them more likely to see doctors regularly and receive recommended care, including colonoscopies and mammographies (thus adding points to their doctors' quality score).

When the researchers adjusted the ratings to account for patient characteristics, more than a third of the 162 primary-care physicians studied changed quality category.

Based on these results, lead researcher Clemens S. Hong, MD, MPH, from Massachusetts General Hospital in Boston, and colleagues concluded: "The association of patient panel characteristics with physician quality scores could lead to inaccurate physician clinical performance rankings that could have implications on how physicians are rewarded and on how resources are allocated within healthcare systems."

Meanwhile, research by Ateev Mehrotra, MD, of the University of Pittsburgh and the RAND Corporation, and colleagues, reported that publicly available data on doctors ranking them by characteristics such as education, sex, board certification, and years of experience, are "poor proxies for performance on clinical quality measures."

For the study, published in the Sept. 13 issue of Archives of Internal Medicine, researchers used claims data from 1.13 million adults enrolled in four commercial health plans from 2004 to 2005, and calculated overall performance scores on 124 quality measures for each of 10,408 Massachusetts physicians.

In searching for associations between performance and physician characteristics obtained from the Massachusetts Board of Registration in Medicine, the team found that only three physician characteristics--being female, board-certified and a graduate of a U.S. medical school--were independently associated with significantly higher overall performance.

To learn more:
- read the article in Medscape Medical News (reg. req.)
- see this Reuters Health piece
- here's the abstract from the Journal of the American Medical Association
- check out this story in MedPage Today
- get the abstract from the Archives of Internal Medicine