Using Medicare data to evaluate docs

There's an interesting editorial in the New York Times about how The Business Roundtable, comprised of reps from 160 large companies, wants "Medicare to release data on payments to individual physicians to help them determine which doctors achieved the best results -- performing the most knee operations with the fewest complications and deaths, for example -- and how the average cost per case differs from doctor to doctor."

That data could be very useful to CME providers as well, obviously. But somehow, I don't see it happening.

Update: Here's a link to more on this topic. A very important caveat is this (from the article):

    Researchers have found immense variation in the amount and cost of care provided by different doctors to Medicare patients with the same disease and the same severity of illness. Patients who receive more care -- more office visits, hospitalizations and operations -- do not necessarily fare better.

    Dr. John E. Wennberg of Dartmouth Medical School, who has studied such variations for more than 30 years, said the Business Roundtable was making "a splendid effort" to compare health care providers. But Dr. Wennberg said: "I would caution against simplistic efforts to measure efficiency. It's very difficult to get reliable data on cost and quality at the individual physician level."

    Conclusions are more likely to be valid when researchers compare groups of 25 or more doctors, Dr. Wennberg said, and it is also essential to know how frequently doctors admit patients to hospitals.

    Even among surgeons performing similar procedures on the same kinds of patients at the same hospital, costs often vary widely.

    Dr. Bruce L. Hall, assistant professor of surgery at Washington University in St. Louis, suggested one reason: Doctors treating the sickest patients seem to develop "costly practice habits," which show up even when they are caring for healthier patients.

Physicians don't work in a vacuum, and there can be many variables that could skew an excellent physician's data, as someone just pointed out to me via e-mail (along with the link to this article). Group-to-group comparisons that take all the environmental factors, including patient compliance, would probably be the most effective way to go.

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