Doctor Economic Profiling

Posted on April 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Q: What is physician economic profiling?

My hospital is considering this investigational methodology and many of us are naturally suspect. Can anyone shed some insight on the matter? Is it for real; punitive, instructional, collegial or are we all just paranoid; and/or any or all of the above! Thanks in advance. 

Dr. Joseph Martin Battalion                                                                             South-East Alabama

 

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One Response

  1. Brent Metfessel, MD, on April 19, 2008 at 10:41 AM said:

    A: Economic-Profiling Explained

    Economic-Profiling is a [not so new] type of medical practice pattern profiling that emphasizes the economic and financial impact of medical practice variations. It is something akin to the six-sigma medical process improvement, but clinical variations in this case translate to dollars, rather than lives lost, or mistake made; but of course cycle back to clinical care quality.

    Usually a cost data -field is used as the measure of interest, and variation from the norm is often determined through severity adjusted case-mix indices. Costs may also be broken down into service categories, such as lab, surgical, radiology, other professional, facility, drug, and other cost categories. Again, each of these service categories should also be case-mix adjusted so that a performance index and/or cost variance can be provided for each one.

    Areas that can be profiled in economic and resource utilization profiling include the following:

    • Consulting, specialty, and sub-specialty referral practices.
    • Prescription habits, including sample dispensation and using generic equivalents, especially for chronic conditions such as hypertension and Type II diabetes.
    • Use of invasive and interventional tests such as angiograms, IVPs, bone scans, and certain biopsies.
    • Use of non-invasive procedures and tests such as CT and MRI scans, cardiovascular stress tests, chest X-rays, and ultrasounds.
    • Average length of hospital stay (ALOS), surgical operating times, use of assistant surgeons, and other utilization parameters.

    If a provider receives a report that points to significant practice variation, the question comes up as to what factor(s) caused the variation. This is where the capability of “drill-down” analysis becomes important.

    In this method, an area of variation is pinpointed and reports are brought up in greater detail specifically concerning that area of variation.

    For example, if a physician shows a high cost variance for migraine headache, a drill-down analysis into the disease state may show that the provider uses CT and MRI scans of the head significantly more frequently than his/her peers. The provider can then be educated about the need for fewer scans, only reserving them for cases having a high index of suspicion for a tumor.

    The importance of balancing economic or cost-based profiling with quality of care profiling must be stressed. Managed care has been purported in many areas of the media to be concerned primarily with profits and costs of care to the detriment of quality. Such instances include reports of overly short maternity lengths of stay, difficulty obtaining access to care, and rushed physician visits.

    Health plans, and the CMS, are increasingly the extent to which doctors and hospital include various quality measures in their practice pattern profile reports in an effort to show the community that they desire to maintain quality while keeping costs down.

    Hopefully this trend will continue as we trust this information is helpful to you.

    Dr. Brent A. Metfessel; MD, MS
    Former Anthem Blue Cross/Shield
    Corporate Clinical Research Coordinator

    More info: http://www.springerpub.com/prod.aspx?prod_id=23759
    Institutional: http://www.HealthcareFinancials.com
    Terms: http://www.HealthDictionarySeries.com

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