The Unreliability of Individual Physician "Report Cards" for Assessing the Costs and Quality of Care of a Chronic Disease

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Abstract
Provider profiling is now widely practiced or attempted in many health care systems.1-4 Those who are paying for or "managing" health care are seeking ways to make health care providers more accountable for both the cost and quality of the care that they supply. Reports comparing hospital mortality rates across hospitals and the Health Plan Employer Data and Information Set performance measures across health plans have been widely implemented.3,5 The goal of the more recent attempts at physician profiling is to hold a single individual (the physician) accountable for what happens to a specific group of patients.3,6-8 Developing and disclosing profiles to consumers is a crucial element of the proposed Consumer Bill of Rights and Responsibilities9 and is considered an important part of creating efficient health care markets.9 Surveys have shown that up to 80% of group practices with capitated patients profile the resource utilization of their physicians.1 Furthermore, for many hospitals and managed care organizations individual physician profiling has become an integral part of medical staff appointment and issuing clinical privileges.8