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Results of physician cost profiling can vary widely, study finds
Date:5/18/2010

Profiles created for physicians based on the cost of the care they provide can vary widely depending upon the methods used by insurance companies to create the profiles, according to a new RAND Corporation study.

Researchers say the findings add to the concern about the accuracy of physician cost profiles that are being created by insurance companies in order to encourage patients to visit low-cost physicians.

"This study provides more evidence that efforts to create physician cost profiles are still a work in progress," said lead author Dr. Ateev Mehrotra, a researcher at RAND, a nonprofit research organization, and a professor at the University of Pittsburgh School of Medicine. "More work is needed in order to make cost profiling a meaningful tool to curb health costs."

The findings are published in the May 18 edition of the Annals of Internal Medicine.

The study found that between 17 percent and 61 percent of physicians would be assigned to a different cost category depending on the methods used -- a change that could have important implications for both patients and physicians. Cost categories, in conjunction with quality scores, are used to assign physicians into performance tiers.

For example, a patient may have to make a $15 co-pay to see a physician assigned to the highest performing tier, but that co-pay might increase to $30 if the physician is in a lower performing tier. If a physician is assigned to a lower performing tier their patients might leave them and switch to a physician in a higher performing tier.

"The cost category assigned to a physician can have important implications for a physician and his or her patients. Our study shows that a physician's cost category can vary from one health plan to another based on how the cost of care is assigned," Mehrotra said.

RAND researchers examined the methods that insurance companies use to assign responsibility for the cost of care
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Contact: Warren Robak
robak@rand.org
310-451-6913
RAND Corporation
Source:Eurekalert

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