Featured Research

from universities, journals, and other organizations

Results of physician cost profiling can vary widely, study finds

Date:
May 18, 2010
Source:
RAND Corporation
Summary:
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 study.

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.

Funding for the study was provided by the U.S. Department of Labor. Other authors of the study are John. L. Adams and Elizabeth A. McGlynn of RAND, and J. William Thomas of the University of Southern Maine.


Story Source:

The above story is based on materials provided by RAND Corporation. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ateev Mehrotra, John L. Adams, J. William Thomas, and Elizabeth A. Mcglynn. The Effect of Different Attribution Rules on Individual Physician Cost Profiles. Annals of Internal Medicine, 2010; 152: 649-654 [link]

Cite This Page:

RAND Corporation. "Results of physician cost profiling can vary widely, study finds." ScienceDaily. ScienceDaily, 18 May 2010. <www.sciencedaily.com/releases/2010/05/100518131716.htm>.
RAND Corporation. (2010, May 18). Results of physician cost profiling can vary widely, study finds. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2010/05/100518131716.htm
RAND Corporation. "Results of physician cost profiling can vary widely, study finds." ScienceDaily. www.sciencedaily.com/releases/2010/05/100518131716.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Nigeria Ups Ebola Stakes on 1st Death

Nigeria Ups Ebola Stakes on 1st Death

Reuters - Business Video Online (July 29, 2014) Nigerian authorities have shut and quarantined a Lagos hospital where a Liberian man died of the Ebola virus, the first recorded case of the highly-infectious disease in Africa's most populous economy. David Pollard reports Video provided by Reuters
Powered by NewsLook.com
Running 5 Minutes A Day Might Add Years To Your Life

Running 5 Minutes A Day Might Add Years To Your Life

Newsy (July 29, 2014) According to a new study, just five minutes of running or jogging a day could add years to your life. Video provided by Newsy
Powered by NewsLook.com
Ebola Outbreak Poses Little Threat To U.S.: CDC

Ebola Outbreak Poses Little Threat To U.S.: CDC

Newsy (July 29, 2014) The Ebola outbreak in West Africa poses little threat to Americans, according to officials with the Centers for Disease Control and Prevention. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins