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Managed care organizations should consider patients' socioeconomic status when profiling a physician's performance

When managed care organizations (MCOs) profile physician performance, they do not take into account the socioeconomic status (SES) of a physician's patients. This approach may penalize physicians caring for poorer patients while inflating the performance ratings of those caring for more affluent patients, since lower SES patients typically have more health problems and less frequently comply with preventive care and treatments.

These are the findings of a recent study supported by the Agency for Healthcare Research and Quality (HS09963). The study was conducted by Peter Franks, M.D., of the University of California School of Medicine, Davis, and Kevin Fiscella, M.D., M.P.H., of the University of Rochester School of Medicine.

The researchers examined the effects of SES (based on ZIP code) of 600,618 patients enrolled in a large New York MCO on 568 physician profiles for preventive care, disease management, and diagnostic testing costs. They specifically correlated the mean practice SES with female patients' likelihood of having a Pap smear or mammogram; for patients with diabetes, having a glycosylated hemoglobin test for blood-sugar level and diabetic eye exam; and diagnostic testing costs. Without adjustment for patient SES, physicians caring for lower SES patients had profiles reflecting lower prevention compliance and higher diagnostic testing costs.

Patient SES, as measured by ZIP code, significantly affected physician profiles for preventive care and diabetes management (except for glycosylated hemoglobin). For eye checks in patients with diabetes, mammograms, and Pap tests respectively, 5, 16, and 21 percent of physicians who were outliers (in the top or bottom 5 percent of use of these medical resources), were no longer outliers after adjustment for patient SES. For all performance measures, the changes in ranking were highly correlated with the mean practice SES. Monitoring patient SES using patient ZIP codes could be a way to target resources to improve outcomes for higher risk patients, conclude the researchers.

See "Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs," by Drs. Franks and Fiscella, in Medical Care 40(8), pp. 717-724, 2002.

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