Powered by: Blackwell Publishing

HRET - Health Research & Educational Trust

HSR - Health Services Research

Impacting Health Practice and Policy Through State-of-the-Art Research and Thinking

Our Next Issue

December 2017
Coming Soon! Read

< ABSTRACT LIST

VOLUME 47 | NUMBER 6 | DECEMBER 2012


A Nonparametric Statistical Method That Improves Physician Cost of Care Analysis

Free Access

Keywords: Statistical methods; physician profiling; nonparametric statistics; cost-efficiency; efficiency index

Objective: To develop a compositing method that demonstrates improved performance compared with commonly used tests for statistical analysis of physician cost of care data.

Data Source: Commercial preferred provider organization (PPO) claims data for internists from a large metropolitan area.

Study Design: We created a nonparametric composite performance metric that maintains risk adjustment using the Wilcoxon rank-sum (WRS) test. We compared the resulting algorithm to the parametric observed-to-expected ratio, with and without a statistical test, for stability of physician cost ratings among different outlier trimming methods and across two partially overlapping time periods.

Principal Findings: The WRS algorithm showed significantly greater within-physician stability among several typical outlier trimming and capping methods. The algorithm also showed significantly greater within-physician stability when the same physicians were analyzed across time periods.

Conclusions: The nonparametric algorithm described is a more robust and more stable methodology for evaluating physician cost of care than commonly used observed-to-expected ratio techniques. Use of such an algorithm can improve physician cost assessment for important current applications such as public reporting, pay for performance, and tiered benefit design.

back to top | back to article index | purchase full article

Copyright© 2017, Health Research & Educational Trust. All rights reserved. Content Disclaimer
Health Research & Educational Trust, 155 North Wacker, 4th Floor Chicago, IL 60606 (312) 422.2600