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Reading: Physician Service Attribution Methods for Examining Provision of Low-Value Care

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Empirical research

Physician Service Attribution Methods for Examining Provision of Low-Value Care

Authors:

Eva Chang ,

echang@rti.org
About Eva
PhD, MPH
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Diana SM Buist,

Group Health Research Institute
About Diana SM
PhD, MPH
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Matthew Handley,

About Matthew
MD
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Roy Pardee,

About Roy
JD, MA
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Gabrielle Gundersen,

About Gabrielle
MPH
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Robert J. Reid

About Robert J.
MD, PhD
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Abstract

Objectives: There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on measurement; a key methodological decision is how to attribute delivered services and procedures. We illustrate the difference in relative and absolute physician- and panel-attributed services and procedures using overuse in cervical cancer screening.

Study Design: A retrospective, cross-sectional study in an integrated health care system.

Methods: We used 2013 physician-level data from Group Health Cooperative to calculate two utilization attributions: (1) panel attribution with the procedure assigned to the physician’s predetermined panel, regardless of who performed the procedure; and (2) physician attribution with the procedure assigned to the performing physician. We calculated the percentage of low-value cervical cancer screening tests and ranked physicians within the clinic using the two utilization attribution methods.

Results: The percentage of low-value cervical cancer screening varied substantially between physician and panel attributions. Across the whole delivery system, median panel- and physician-attributed percentages were 15 percent and 10 percent, respectively. Among sampled clinics, panel-attributed percentages ranged between 10 percent and 17 percent, and physician-attributed percentages ranged between 9 percent and 13 percent. Within a clinic, median panel-attributed screening percentage was 17 percent (range 0 percent–27 percent) and physician-attributed percentage was 11 percent (range 0 percent–24 percent); physician rank varied by attribution method.

Conclusions: The attribution method is an important methodological decision when developing low-value care measures since measures may ultimately have an impact on national benchmarking and quality scores. Cross-organizational dialogue and transparency in low-value care measurement will become increasingly important for all stakeholders.

How to Cite: Chang E, Buist DS, Handley M, Pardee R, Gundersen G, Reid RJ. Physician Service Attribution Methods for Examining Provision of Low-Value Care. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2017;4(1):29. DOI: http://doi.org/10.13063/2327-9214.1276
Published on 13 Jan 2017.
Peer Reviewed

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