A methodology for choosing a physician profiling system: the case of First Option Health Plan.
The public continues to demand improved health care at affordable costs. It appears that this public pressure will force health maintenance organizations (HMOs) and other health care providers to face their toughest days in the years to come. They will need to find solutions to resolve this "quality and cost" problem. One method that is likely to have the ability to improve quality of care and control costs is physician profiling. That is, data related to a physician's care or outcomes can be collected and compared with profiles of various populations, for example, other similar providers in a relatively close geographical proximity. This article examines the issues involved in physician profiling, including the characteristics of profiling systems and the direct and indirect benefits of having such a system. Further, the article uses an actual HMO example to discuss considerations that administrators should make when choosing a physician profiling system.
Nickerson
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Midtown Health Center, New York, New York, USA.
Rutledge
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RW
D019058:Community Networks / Q000191:economics / Q000458:organization & administration; D003363:Cost Control / Q000379:methods; D003625:Data Collection; D003628:Database Management Systems; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D017146:Models, Organizational; D009515:New Jersey; D019982:Organizational Case Studies; D018024:Peer Review, Health Care / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000145:classification* / Q000191:economics; D011795:Surveys and Questionnaires