An analytical approach to improving physician performance

Health care reform has strengthened the link between performance and reimbursement, exemplified by value-based purchasing and accountable care organizations. This has led to a heightened responsibility for physician leaders to improve physician performance. Determining whether statistically significant differences in physician performance exist provides another piece of information that assists the physician executive in deriving the improvement strategy. A physician leader could not expect that attempts to reduce physician performance variability would yield meaningful improvement results. The last piece of information in evaluating physician performance is the distribution of outcomes across the performance categories of "better than expected," "as expected" and "worse than expected." The expected component of this measurement is the predicted risk-adjusted outcome based on the severity of illness among the physician's patient population. By statistically summarizing these differences across a group of patients attributed to a specific physician, a physician leader can determine whether systematic departures from risk-adjusted expected length of stay are present.