Researchers at the University of Southern Maine examined the feasibility of using physician profiling software systems to rank physician specialists by their "cost efficiency"—that is, the extent to which the actual costs incurred by their patients are greater or less than expected for those patients, on average.
The researchers assessed whether two commercially available software packages could produce consistent rankings for each specialty:
- When the two packages were compared one to the other.
- When the rankings were compared year to year.
This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO).
Agreement between rankings from consecutive years was substantial for cardiology, general surgery and neurology, but less so for primary care specialties such as family practice, internal medicine and gynecology.
Agreement between rankings using the two software systems was also substantial for cardiology, general surgery and neurology. There was little agreement between rankings for family practice, foot surgery, internal medicine and gynecology.
If pharmacy claims data are absent, accurate rankings are still feasible for cardiology, general surgery and neurology, but not for family practice.
With the use of appropriate methodologies, health plans and patients can feel confident of cost-efficiency rankings for specialists such as cardiologists, general surgeons and neurologists.
Caution is needed when interpreting rankings for others, such as family practitioners, gynecologists, internists and foot surgeons.
Although cost-efficiency rankings might still be useful for feedback to physicians and for improving practice management, using inaccurate scores to reward or penalize physicians should be avoided.