Profiling efficiency and quality of physician organizations in medicare

Health Care Financing Review

Volumn 29, Issue 1, 2007, Pages 31-43

  Pope, Gregory C ^a   Kautter, John ^a  

^a RTI INTERNATIONAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CASE MIX; COST EFFECTIVENESS ANALYSIS; HEALTH CARE QUALITY; HUMAN; MARKET; MEDICARE; METHODOLOGY; ORGANIZATION; PHYSICIAN; POWER ANALYSIS; STATISTICAL ANALYSIS; UNITED STATES;

BENCHMARKING; CLINICAL COMPETENCE; EFFICIENCY, ORGANIZATIONAL; HEALTH SERVICES RESEARCH; HUMANS; MEDICARE; PRACTICE MANAGEMENT, MEDICAL; QUALITY INDICATORS, HEALTH CARE; UNITED STATES;

EID: 37149052490     PISSN: 01958631     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (19)

1. Cave, D.G.: Profiling Physician Practice Patterns Using Diagnostic Episode Clusters. Medical Care 33(5):463-486, May 1995.
2. Centers for Medicare & Medicaid Services: CMS Physician Focus Quality Initiative: Chronic Disease and Prevention Measures. 2005. Internet address: http://www.cms.hhs.gov/PhysicianFocusedQual-Inits/downloads/ PFQIClinicalMeasures200512.pdf (Accessed 2007.)
3. Centers for Medicare & Medicaid Services: CMS HQI Demonstration Project: Composite Quality Score Methodology Review. 2004. Internet address: http://www.cms.hhs.gov/HospitalQualityInits/downloads/ HospitalCompositeQualityScoreMethodologyOverview.pdf (Accessed 2007.)
4. Fisher, E.S., Staiger, D.O, Bynum, J.P.W., et al.: Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Affairs 26(1):w44-w57, 2006.
5. Hofer, T.P., Hayward, R.A., Greenfield, S., et al.: The Unreliability of Individual Physician "Report Cards" for Assessing the Costs and Quality of Care of a Chronic Disease. Journal of the American Medical Association 281(22):2098-2105, June 9, 1999.
6. Landrum, M.B., Bronskill, S.E., and Normand, S.T.: Analytic Methods for Constructing Cross-Sectional Profiles of Health Care Providers. Health Services & Outcomes Research Methodology 1(1):23-47, 2000.
7. Leapfrog Group & Bridges to Excellence: Measuring Provider Efficiency, Version 1.0. December 31, 2004. Internet address: http://www.bridgestoexcellence.org/assets/Documents/ Program_Evaluation_Documents/Provider_Efficiency_Whitepaper/ Measuring_Provider_Efficiency_Version1_12-31-20041.pdf (Accessed 2007.)
8. McCall, N.T., Pope, G.C., and Adamache, K.W.: Research and Analytic Support for Implementing Performance Measurement in Medicare Fee for Service: First Annual Report. Health Economics Research, Inc. Waltham, MA. 1998.
9. Medicare Payment Advisory Commission: Report to the Congress: Increasing the Value of Medicare. Washington, DC. 2006.
10. Medicare Payment Advisory Commission: Report to the Congress: Medicare Payment Policy. Washington, DC. 2005.
11. Pope, G.C., Kautter, J., Ellis, R.P., et al.: Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model. Health Care Financing Review 25(4):119-141, Summer 2004.
12. Robinson, J.C.: Hospital Tiers in Health Insurance: Balancing Consumer Choice with Financial Incentives. Web Exclusive. Health Affairs W3-135 - W3-146, March 19, 2003. Internet address: http://content.healthaffairs.org/cgi/ reprint/hlthaff.w3.135v1 (Accessed 2007.)
13. Rosenthal, M.B., Fernandopulle, R., Song, H.R., et al.: Paying for Quality: Providers' Incentives for Quality Improvement. Health Affairs 23(2):127-141, March/April 2004.
14. Rosenthal, M.B. and Epstein, A.M.: Pay for Performance in Commercial HMOs. New England Journal of Medicine 355(18):1895-1902, November 2, 2006.
15. Sandy, L.G.: The Future of Physician Profiling. Journal of Ambulatory Care Management 22(3): 1-16, 1999.
16. Thomas, J.W.: Should Episode-Based Economic Profiles Be Risk Adjusted to Account for Differences in Patients' Health Risks? Health Services Research 41(2):581-598, 2006.
17. Thomas, J.W., Grazier, K.L., and Ward, K.: Economic Profiling of Primary Care Physicians: Consistency Among Risk-Adjusted Measures. Health Services Research 39(4):Part I, 985-1003, August 2004.
18. Tucker, A.M., Weiner, J.P., Honigfeld, S., et al.: Profiling Primary Care Physician Resource Use: Examining the Application of Case Mix Adjustment. Journal of Ambulatory Care Management 19:60-80, 1996.
19. U.S. Government Accountability Office: Consumer-Directed Health Plans. Pub. No. GAO-06-514. U.S. Government Printing Office. Washington, DC. April 2006.