Physician Cost Profiling

To the Editor: Adams et al. (March 18 issue) 1 highlight problems in the use of claims data to profile physicians. We agree caution is necessary, but not all “profiling” is problematic. Three modifications can improve estimates: excluding infrequent and expensive items outside the physician's control, focusing on the primary care physician, and being condition-specific. For the profiling of resource use (i.e., cost) related to specific chronic illnesses, we recommend setting aside inpatient care. We evaluated data on 20,073 year-long episodes of care for patients with diabetes (excluding inpatient costs) in a large medical group in 2006, 2007, and 2008. Costs . . .