Physician profiling. How it can be misleading and what to do.
Hospitals want to identify physicians whose practice patterns are more costly or less costly than their colleagues', because of cost containment pressures from government, employers, and insurers. But whether a given physician is high cost or low cost depends strongly on the classification system used to define case types. Since diagnosis related groups (DRGs) are used by the Health Care Financing Administration for payment of Medicare beneficiaries, hospitals often use DRGs to compare physicians' use of resources. DRGs can, however, lead to incorrect conclusions because they do not account adequately for differences in the severity of patients' illnesses. The severity of illness as measured by the Computerized Severity Index (CSI) can be used to create meaningful profiles of physician practice. Profiles generated in this fashion effectively identify genuinely high-cost physicians and help them change their practice patterns.
D003363:Cost Control; D005376:Financial Management / Q000379:methods*; D005377:Financial Management, Hospital / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012720:Severity of Illness Index; D014481:United States