Physician Performance: Report Cards Under Development but Challenges Remain Page: 4 of 38
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as innovators in the area of consumer health care information. The health
plans we selected have publicly reported the results of their comparisons
of physicians in their networks. We performed our work from
January 1999 through August 1999 in accordance with generally accepted
government auditing standards.
Results in Brief
Measuring performance in health care is challenging in terms of
identifying measures that truly reflect the quality of care individuals
receive. It is also difficult to make comparisons across plans or providers
that account for differences in the patients whom they treat that can affect
health care outcomes. Measuring the performance of physician groups and
individual physicians is even more difficult. Individual physicians or
groups perform a wide variety of services and typically perform any
individual service for a small number of patients. Only a fraction of these
services can be clearly linked to a measurable outcome. To make
meaningful comparisons among physicians, analysts must adjust any
measure selected to take into consideration the extent to which a
characteristic like the severity of a medical condition affects the outcomes
from care. To avoid these difficulties, current approaches to performance
measurement generally focus on physician groups instead of individual
physicians, and they measure processes such as whether services are
provided in accordance with agreed-upon norms rather than outcomes of
care. Adding to the challenges, however, are concerns that consumers
have regarding the privacy of their personal medical information and that
physicians have regarding the accuracy of performance measurement
Even though the data and measures that are currently available are
limited, several different private and public organizations have developed
physician and physician group report cards using these data and measures.
For example, two purchasing groups and two California health plans are
avoiding some problems associated with measuring the performance of
individual physicians (such as small sample sizes) by reporting on the
performance of physician groups. In addition, in New York and
Pennsylvania, state agencies that have reported on the performance of
individual cardiac surgeons since the early 1990s have reported improved
performance scores since they began publishing them. While significant,
these efforts at physician report cards are in their early stages or are
limited in scope, and difficulties remain. For example, medical group
report cards provide information that is closer to the level of the individual
physician than health plan report cards do but, depending on the size of
GAO/HEHS-99-178 Physician Report Cards
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United States. General Accounting Office. Physician Performance: Report Cards Under Development but Challenges Remain, report, September 30, 1999; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc293055/m1/4/: accessed October 21, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.