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.

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