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Home / News & IndustryManaged Care Insight and Analysis
Updated: May 25, 2010
Most Primary-Care Physician Practices May Be Too Small To Measure Quality Adequately

Rethinking the approach to performance measurement in ambulatory care may be necessary for Medicare if the United States is to reverse the high and rising costs of healthcare – even as evidence grows that quality is lagging.

Now the wisdom of P4P programs is coming under scrutiny.

Researchers are beginning to realize that individual primary care physicians may not treat enough Medicare patients as those in group practices to reliably measure significant differences in common measures of quality and cost performance. The findings were printed in the Dec. 9 issue of JAMA.

David Nyweide of CMS and other colleagues examined whether statistically meaningful differences on measures of quality and cost could be measured more reliably for primary care groups than for individual physicians.

The answer was no. "Relatively few primary care physician practices are large enough to reliably measure [the] relative differences in common measures of quality and cost performance among fee-for-service Medicare patients," the study in JAMA said.

The researchers drew their conclusions by looking at the Medicare patient loads of individual physicians in three treatment areas – mammography, diabetes and congestive heart failure (CHF) hospitalization.

"None of the primary care physician practices had sufficient caseloads to detect 10 percent relativedifferences in preventable [CHF] hospitalization or 30-day readmission after discharge …," the researchers said.

The percentage of primary care physician practices with sufficient caseloads to detect 10 percent relative differences in performance ranged from less than 10 percent of practices with fewer than 11 primary care physicians to 100 percent of practices with more than 50 primary care physicians.

"Novel measurement approaches appear to be needed for the twin purposes of performance assessment and accountability," the authors concluded.

Address: Centers for Medicare and Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244; (877) 267-2323,

  This article was taken from:
Pay-For-Performance Reporter

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