Availability of data for measuring physician quality performance.
OBJECTIVE
To evaluate measurement of physician quality performance, which is increasingly used by health plans as the basis of quality improvement, network design, and financial incentives, despite concerns about data and methodological challenges.


METHODS
Evaluation of health plan administrative claims and enrollment data.


METHODS
Using administrative data from 9 health plans, we analyzed results for 27 well-accepted quality measures and evaluated how many quality events (patients eligible for a measure) were available per primary care physician and how different approaches for attributing patients to physicians affect the number of quality events per physician.


RESULTS
Fifty-seven percent of primary care physicians had at least 1 patient who was eligible for at least 1 of the selected quality measures. Most physicians had few quality events for any single measure. As an example, for a measure evaluating appropriate treatment for children with upper respiratory tract infections, physicians on average had 14 quality events when care was attributed to physicians if they saw the patient at least once in the measurement year. The mean number of quality events dropped to 9 when attribution required that the physician provide care in at least 50% of a patient's visits. Few physicians had more than 30 quality events for any given measure.


CONCLUSIONS
Available administrative data for a single health plan may provide insufficient information for benchmarking performance for individual physicians. Efforts are needed to develop consensus on assigning measure accountability and to expand information available for each physician, including accessing electronic clinical data, exploring composite measures of performance, and aggregating data across public and private health plans.
Scholle
Sarah Hudson
SH
National Committee for Quality Assurance, 1100 13th St NW, Ste 1000, Washington, DC 20005, USA. scholle@ncqa.org
Roski
Joachin
J
Dunn
Daniel L
DL
Adams
John L
JL
Dugan
Donna Pillitterre
DP
Pawlson
L Gregory
LG
Kerr
Eve A
EA
D019985:Benchmarking; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D008485:Medical Audit / Q000379:methods*; D010821:Physicians, Family / Q000592:standards*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D014481:United States