Purchasers of health care are experimenting with different approaches to rein in rising costs. One approach is to focus attention on the relative costs of individual physicians and to give consumers incentives to seek care from physicians with relatively lower spending patterns. It makes sense to focus on physicians, because they drive much of health care spending through the decisions they make (e.g., which tests to order, what drugs to prescribe, which referrals to make, and what procedures to perform).
Purchasers have developed methods for creating overall assessments of practice patterns called cost profiles. A cost profile is a single number that places a physician on a relative scale of spending. Purchasers use cost profiles to identify physicians who are high or low cost (similar in concept to the number of dollar signs indicating the expense one might encounter at a particular restaurant).
We conducted a series of studies to examine the different technical decisions necessary for creating cost profiles and the usefulness of cost profiles for helping consumers select more efficient physicians. These include studies addressing:
- How do attribution rules affect the assignment of cost categories?
- How reliable are physician cost profiles?
- Should cost profiles focus on individual physicians or physician groups?
- What is the association between experience and cost profiles?
RAND published a research brief summarizing much of our work in this area. Individual manuscripts are included below:
- Adams JL, Mehrotra A, Thomas JW, and McGlynn EA, “Physician Cost Profiling—Reliability and Risk of Misclassification,” The New England Journal of Medicine, Vol. 362, No. 11, March 18, 2010, pp. 1014–1021.
- Mehrotra A, Adams JL, Thomas JW, and McGlynn EA, “The Effect of Different Attribution Rules on Individual Physician Cost Profiles,” Annals of Internal Medicine, Vol. 152, No. 10, May 18, 2010, pp. 649–654.
- Mehrotra A, Adams JL, Thomas JW, and McGlynn EA, “Cost Profiles: Should the Focus Be on Individual Physicians or Physician Groups?” Health Affairs, Vol. 29, No. 8, August 2010, pp. 1532–1538.
- Adams JL, Mehrotra A, Thomas JW, and McGlynn EA, Physician Cost Profiling—Reliability and Risk of Misclassification Detailed Methodology and Sensitivity Analyses, Santa Monica, Calif.: RAND Corporation, TR-799-DOL, 2010.
- Adams JL, McGlynn EA, Thomas JW, Mehrotra A. Incorporating statistical uncertainty in the use of physician cost profiles. BMC Health Services Research. 2010;10:57 (doi:10.1186/1472-6963-10-57). PMCID: PMC2842268.
- Hussey PS, Wertheimer, S. Mehrotra A. The Association Between Health Care Quality and Cost: A Systematic Review. Annals of Internal Medicine. 2013;158:27-34.
- Mehrotra A. Reid RO, Adams JL, Friedberg MW, McGlynn EA, Hussey PS. Physicians with the Least Experience Have Higher Cost Profiles than do Physicians with the most experience. Health Affairs. 2012;31(11):2453-2463.
- Timbie JW, Hussey PS, Adams JL, Ruder TW, Mehrotra A. Impact of socioeconomic adjustment on physicians' relative cost of care. Med Care. 2013 May;51(5):454-60.
- Yu H, Mehrotra A, Adams JL, Reliability of Utilization Measures for Primary Care Physician Profiling. Health Care. 2013 June; 1(1-2): 22-29. No PMC req.