Physician Performance

Physician Performance| Physician Recognition Program Linked to Improved Health and Spending Savings

Physician Performance| In 2006, a number of Colorado health plans and employers joined together in a national program called Bridges to Excellence (BTE). Under the leadership of the Colorado Business Group on Health (CBGH), these groups agreed to recognize physicians who voluntarily applied to this national organization and who could demonstrate that most of their patients could meet rigorous standards for metrics on blood pressure, cholesterol, blood sugar, and other vital statistics. BTE recognizes and rewards physician performance to those who deliver superior patient care. With a special emphasis on chronic conditions, the BTE collaboration among employers, health plans and physicians is designed to spur continuous improvements in the quality of health care.

The BTE program is based on the theory that a patient whose health is carefully managed is more likely to avoid or delay illness or complications of illness. CBGH decided to look at raw data to answer the question: Do BTE recognized physicians have better outcomes for their patients? First, what is a better outcome? A better outcome for a patient with diabetes is that the control of the disease allows the patient to avoid trips to the emergency department, to avoid hospitalizations and to avoid bad complications such as heart attack or stroke. The same can be said for patients receiving cardiac care.

How can we measure BTE physician performance? CBGH compared the performance of BTE recognized physicians with physicians who were also primary care physicians, but who were not recognized. Both utilization and cost measures were used. A utilization measure is determined by traditional actuarial methods, for example how many patients per thousand went to the emergency department and how many days were spent in the hospital? For costs, more clinically-based measures defined by the proprietary PROMETHEUS Payment Model ® were used. Most simply these are:

  • Relevant Costs. Costs that relate specifically and exclusively to a patient’s underlying condition and co-morbid condition. For example, for diabetes, it would include routine doctor visits, medicines, lab tests, specialists and potentially avoidable conditions.
  • Potentially Avoidable Costs (PAC). That portion of the relevant costs that are for services that reflect poor outcomes for patients, such as emergency department visits, admission to the hospital, heart attacks and other complications of the disease. Studies have shown that patients whose diabetes is well-managed are more likely to be able to avoid or defer poor outcomes.

Using two years’ worth of medical claims for a national health care plan that covers Colorado, CBGH looked at physician performance measures for six chronic conditions: Asthma, Coronary Artery Disease (CAD), Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Gastro-esophageal Reflux Disease (GERD), and Hypertension.

What Was Observed. For diabetes, it was found that BTE recognized physicians have:

  • Lower Costs. Diabetes recognized physicians had lower average relevant costs than non-recognized physicians. And, they also showed a strong trend of lower average potentially avoidable costs as well.
  • Better Utilization Rates. Recognized physicians fared better on a variety of utilization measures including:

– Significantly lower number of emergency room visits (Figure 1)
– Less total days spent in a hospital (Figure 2)
– Lower frequency of hospital admissions (Figure 3)
– Higher rates of getting routine care that leads to better diabetes control

This means that the patients with diabetes who see BTE recognized doctors are less likely than other similar patients to have to visit the emergency room, or be admitted to the hospital in general. Patients of recognized physicians are also more likely to get all the routine care they need.

Interestingly, for coronary artery disease, BTE recognized physicians performance demonstrated significantly lower average relevant costs as well.

Other Observations. It is interesting to note that other than the cardiac and diabetes measures that are part of the BTE Recognition program, recognition as a whole did not translate into better care in terms of either costs and utilization for the other chronic diseases mentioned above.

Conclusions. No one should be surprised that in medicine, as in other fields, providers perform better for conditions on which they are measured. We applaud the efforts those physicians have made to attain cardiac and diabetes recognition, and patients can appreciate top quality management of their disease.

To find a physician who is recognized for diabetes or cardiac care, please visit www.coloradohealthonline.org and click on the Health Matters Quality Report: Physicians. If you have other questions regarding physician performance, please call the Colorado Business Group on Health at 303-922-0939.