Journal of Healthcare Management - May/June 2014 - (Page 224)

Composite Model for Profiling Physicians Across Domains of Care Lori R. Pelletier, PhD, associate vice president, UMass Memorial Health Care, and assistant professor, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Sharon A. Johnson, PhD, associate professor, Operations and Industrial Engineering, Worcester Polytechnic Institute School of Business, Worcester; Edward R. Westrick, MD, president of Medical Affairs, medical director, and primary care physician, PACE Organization of Rhode Island, Providence; Elaine R. Fontaine, director, Data Quality and Analytics, Rhode Island Quality Institute, Providence; Alan D. Krinsky, PhD, senior data analyst, Office of Clinical Integration, UMass Memorial Health Care; Robert A. Klugman, MD, vice president, Medical Affairs, Eastern Region, Kindred Healthcare, Andover, Massachusetts; and Arlene S. Ash, PhD, professor, Quantitative Health Sciences, University of Massachusetts Medical School E X E C U T I V E S U M M A R Y Physician profiling methods are envisioned as a means of promoting healthcare quality by recognizing the contributions of individual physicians. Developing methods that can reliably distinguish among physicians' performance is challenging because of small sample sizes, incomplete data, and physician panel differences. In this study, we developed a hierarchical, weighted composite model to reliably compare primary care physicians across domains of care, and we demonstrated its use within a clinical system. We evaluated 199 primary care physicians from a large integrated healthcare delivery system using 19 quality and two efficiency measures taken from the Healthcare Effectiveness Data and Information Set and existing pay-for-performance programs. Individual measures were calculated, compared to benchmarks, and grouped into two composites: one focused on quality and one on efficiency. Each composite was fitted to the model, assessed for reliability (signal-to-noise ratio), and weighted to create a single summary score for each primary care physician. The quality-of-care composite had a median reliability of .98, with 99.5% of all physician reliability estimates exceeding threshold. The efficiency composite had a median reliability of .97, with 94.9% of all physician reliability estimates exceeding threshold. Our results demonstrate that reliable physician profiling is possible across care domains using a hierarchical composite model based on multiple data. The model was used to distribute incentive payouts among primary care physicians but is adaptable to many settings. For more information about the concepts in this article, contact Dr. Pelletier at lori.pelletier@umassmemorial.org. 224

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2014

Journal of Healthcare Management - May/June 2014
Contents
Interview With Christopher D. Van Gorder, FACHE, President and CEO of Scripps Health
Successful Strategic Planning for a Reformed Delivery System
You, Inc.
Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study
Physician Clinical Alignment and Integration: A Community–Academic Hospital Approach
Employer-Based Coverage and Medical Travel Options: Lessons for Healthcare Managers
Composite Model for Profiling Physicians Across Domains of Care

Journal of Healthcare Management - May/June 2014