Physician Service Attribution Methods for Examining Provision of Low-Value Care.
EGEMS (Wash DC)
; 4(1): 1276, 2016.
Article
in En
| MEDLINE
| ID: mdl-28203612
ABSTRACT
OBJECTIVES:
There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on measurement; a key methodological decision is how to attribute delivered services and procedures. We illustrate the difference in relative and absolute physician- and panel-attributed services and procedures using overuse in cervical cancer screening. STUDYDESIGN:
A retrospective, cross-sectional study in an integrated health care system.METHODS:
We used 2013 physician-level data from Group Health Cooperative to calculate two utilization attributions (1) panel attribution with the procedure assigned to the physician's predetermined panel, regardless of who performed the procedure; and (2) physician attribution with the procedure assigned to the performing physician. We calculated the percentage of low-value cervical cancer screening tests and ranked physicians within the clinic using the two utilization attribution methods.RESULTS:
The percentage of low-value cervical cancer screening varied substantially between physician and panel attributions. Across the whole delivery system, median panel- and physician-attributed percentages were 15 percent and 10 percent, respectively. Among sampled clinics, panel-attributed percentages ranged between 10 percent and 17 percent, and physician-attributed percentages ranged between 9 percent and 13 percent. Within a clinic, median panel-attributed screening percentage was 17 percent (range 0 percent-27 percent) and physician-attributed percentage was 11 percent (range 0 percent-24 percent); physician rank varied by attribution method.CONCLUSIONS:
The attribution method is an important methodological decision when developing low-value care measures since measures may ultimately have an impact on national benchmarking and quality scores. Cross-organizational dialogue and transparency in low-value care measurement will become increasingly important for all stakeholders.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Observational_studies
/
Prognostic_studies
Language:
En
Journal:
EGEMS (Wash DC)
Year:
2016
Document type:
Article