Incorporating Statistical Uncertainty in the Use of Physician Cost Profiles

Published In: BMC Health Services Research, v. 10, no. 57, Mar. 7, 2010, p. 1-7

Posted on RAND.org on December 31, 2009

by John L. Adams, Elizabeth A. McGlynn, William Thomas, Ateev Mehrotra

Read More

Access further information on this document at BioMedCentral

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: Physician cost profiles (also called efficiency or economic profiles) compare the costs of care provided by a physician to his or her peers. These profiles are increasingly being used as the basis for policy applications such as tiered physician networks. Currently tiers (low, average, high cost) are defined by health plans based on percentile cut-offs which do not account for statistical uncertainty. In this paper we compare the percentile cut-off method to another method, using statistical testing, for identifying high-cost or low-cost physicians. METHOD: We created a claims dataset of 2004-2005 data from four Massachusetts health plans. We employed commercial software to create episodes of care and assigned responsibility for each episode to the physician with the highest proportion of professional costs. A physicians' cost profile was the ratio of the sum of observed costs divided by the sum of expected costs across all assigned episodes. We discuss a new method of measuring standard errors of physician cost profiles which can be used in statistical testing. We then assigned each physician to one of three cost categories (low, average, or high cost) using two methods, percentile cut-offs and a t-test (p-value < 0.05), and assessed the level of disagreement between the two methods. RESULTS: Across the 8689 physicians in our sample, 29.5% of physicians were assigned a different cost category when comparing the percentile cut-off method and the t-test. This level of disagreement varied across specialties (17.4% gastroenterology to 45.8% vascular surgery). CONCLUSIONS: Health plans and other payers should address statistical uncertainty when they use physician cost-profiles to categorize physicians into low or high-cost tiers.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.