Navigation Links
Results of physician cost profiling can vary widely, study finds

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 when a patient sees multiple doctors. Insurance companies have developed different "attribution rules" to assign responsibility for the cost of care based on patterns derived from health care claims.

For example, one rule might assign the cost of care for a patient to the physician who accounts for the highest percentage of patient visits. Another rule assigns the cost of care for a patient to the physician who accounts for the highest percentage of the costs incurred in delivering care.

To examine the differences between 12 different attribution rules, RAND researchers analyzed information from four commercial health plans in Massachusetts that enroll 1.1 million adults. Researchers found that a physician's cost profile could vary widely depending on which attribution rule was applied.

Mehrotra said that an important step for the future is for insurance plans to be more transparent about the methods they use to assign care costs as a part of their physician cost profiling efforts, allowing physicians and others to review the rules that are being used.

In addition, he suggests that insurance plans enlist physicians into efforts to create attribution rules used for cost profiling. Doing so will help build consensus about what is the best method and help build support for the overall cost-saving strategy.


Contact: Warren Robak
RAND Corporation

Related medicine news :

1. First Communications, Inc. Announces Audited Results for the Year Ended December 31, 2009
2. With Cosmetic Surgery Becoming More Common, Ft. Lauderdale Doctor says Choosing a Board Certified Plastic Surgeon is Important for Safe, Natural-Looking Results
3. Sponsoring by the pharmaceutical industry can bias the results of drug studies
4. Phase II study of an oral therapy for Gaucher disease yields positive results
5. Site Steering Launches Keyword Targeted Small Business Internet Video Advertising Program That Achieves First Page Search Results Within Days
6. Food Psychology Coaches Launch New Weight Loss Program for Ultimate Life Fitness Results
7. Glued graft for Pterygium Yield Better Cosmetic Results
8. USA TODAY Announces Results Of Twitter Hashtag Campaign For Charity
9. IMPACT results show potential cancer treatment
10. Direct patient access to imaging test results could result in increased patient anxiety and physician overload
11. Guaranteed PR Results from Borough PR with the New ‘PRcheck'
Post Your Comments:
(Date:6/25/2016)... ... ... The temporary closing of Bruton Memorial Library on June 21 due to a possible lice ... overlooked aspect of head lice: the parasite’s ability to live away from a human host, ... a necessary one in the event that lice have simply gotten out of control. , ...
(Date:6/25/2016)... ... June 25, 2016 , ... Dr. Calvin Johnson has dedicated ... has implemented orthobiologic procedures as a method for treating his patients. The procedure ... doctors to perform the treatment. Orthobiologics are substances that orthopaedic surgeons use to ...
(Date:6/24/2016)... ... June 24, 2016 , ... Those who have experienced ... feelings, many turn to unhealthy avenues, such as drug or alcohol abuse, as a ... has released tools for healthy coping following a traumatic event. , Trauma sufferers tend ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... Global law ... magazine’s 2016 Legal Elite. The attorneys chosen by their peers for this recognition are ... , Seven Greenberg Traurig Shareholders received special honors as members of this year’s Legal ...
(Date:6/24/2016)... , ... June 24, 2016 , ... People across the ... Genome magazine’s Code Talker Award, an essay contest in which patients and their families ... to be presented at the 2016 National Society of Genetic Counselors (NSGC) Annual Education ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016   Pulmatrix, Inc ., ... developing innovative inhaled drugs, announced today that it was ... Investments reconstituted its comprehensive set of U.S. and ... "This is an important milestone for Pulmatrix," said Chief ... shareholder awareness of our progress in developing drugs for ...
(Date:6/23/2016)... 2016 Any dentist who has made an implant ... process. Many of them do not even offer this as ... high laboratory costs involved. And those who ARE able to ... a high cost that the majority of today,s patients would ... Parsa Zadeh , founder of Dental Evolutions Inc. and inventor ...
(Date:6/23/2016)... June 23, 2016 Capricor ... ), a biotechnology company focused on the discovery, ... that patient enrollment in its ongoing randomized HOPE-Duchenne ... exceeded 50% of its 24-patient target. Capricor expects ... third quarter of 2016, and to report top ...
Breaking Medicine Technology: