Small Caseloads Hinder Gauging Medicare Performance

Study finds most primary care practices have too few beneficiaries to reliably assess performance
By Eric Metcalf
HealthDay Reporter

TUESDAY, Dec. 8 (HealthDay News) -- Most primary care physicians participating in Medicare work in practices with too few Medicare beneficiaries to reliably assess their practices' performance on common measures of quality and cost performance, according to research published in the Dec. 9 issue of the Journal of the American Medical Association.

David J. Nyweide, Ph.D., of the Centers for Medicare & Medicaid Services in Baltimore, and colleagues used data from the 2005 Medicare Part B 20-percent sample to assess the number of Medicare patients per practice. They also calculated the caseloads needed to detect 10-percent relative differences in quality and costs, using several benchmarks.

The researchers found that almost no practices with five or fewer primary care physicians had enough patients to reliably find a 10-percent relative difference in costs or any quality control measure. Fewer than 10 percent of practices with six to 10 physicians had a caseload that could reliably show a 10-percent difference in costs. All practices with more than 50 primary care physicians had the caseload to detect relative differences in costs, hemoglobin A1C testing, and mammography.

"More could be known if data could be aggregated from all payers, not just Medicare. Creating shared pools of transparent performance information for Medicare, Medicaid, and private insurers would be a step toward maturation in the ability to improve U.S. health care," writes the author of an accompanying editorial, who presents several possible approaches to this measurement problem.

A co-author of the study is on the board of directors of the American Medical Group Foundation.

Full Text (subscription or payment may be required)
Editorial (subscription or payment may be required)

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Powered by

jQuery UI Accordion - Default functionality

For life-long learning and continuing professional development, come to Lippincott's NursingCenter.

Nursing Jobs Plus
Featured Jobs
Recommended CE Articles

Blunt Chest Trauma
Journal of Trauma Nursing, November/December 2014
Expires: 12/31/2016 CE:2 $21.95

The School Age Child with Congenital Heart Disease
MCN, The American Journal of Maternal/Child Nursing, January/February 2015
Expires: 2/28/2017 CE:2.5 $24.95

Understanding multiple myeloma
Nursing Made Incredibly Easy!, January/February 2015
Expires: 2/28/2017 CE:2 $21.95

More CE Articles

Subscribe to Recommended CE

Recommended Nursing Articles

Comprehensive Care: Looking Beyond the Presenting Problem
Journal of Christian Nursing, January/March 2015
Free access will expire on March 2, 2015.

Pain and Alzheimer dementia: A largely unrecognized problem
Nursing Made Incredibly Easy!, January/February 2015
Free access will expire on February 16, 2015.

Glycemic control in hospitalized patients
Nursing2015 Critical Care, January 2015
Free access will expire on February 16, 2015.

More Recommended Articles

Subscribe to Recommended Articles

Evidence Based Practice Skin Care Network NursingCenter Quick Links What’s Trending Events