Health Affairs

Health Affairs, doi: 10.1377/hlthaff.27.4.w250 (Published online May 20, 2008) © 2008 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Beyond The Efficiency Index: Finding A Better Way To Reduce Overuse And Increase Efficiency In Physician Care

Robert A. Greene ¹, Howard B. Beckman ^2*, Thomas Mahoney ³

¹ At the time this paper was prepared, Robert Greene was associate medical director of the Rochester Individual Practice Association (RIPA), in New York, and a clinical assistant professor in the Department of Medicine, University of Rochester (UR) School of Medicine and Dentistry. He is now vice president, Clinical Analytics, for UnitedHealthcare, part of the UnitedHealth Group.
² Howard Beckman is medical director of RIPA and a clinical professor, internal medicine, at the UR School of Medicine and Dentistry.
³ Thomas Mahoney is chief executive officer and executive director of RIPA and a clinical assistant professor in the UR School of Medicine and Dentistry.

^*Corresponding author.

Abstract

Current strategies for addressing health care costs stress physician performance measurement and commonly use an efficiency index (EI). During seven years of conducting individual practitioner pay-for-performance (P4P), we found that using EIs hindered our work on reducing overuse of services. This paper offers an alternative approach through the identification of variation in key cost drivers. As proof of concept, we apply this model to hypertension care. We then describe a project that decreased apparent overuse of fiberoptic laryngoscopy among otorhinolaryngologists. Focusing directly on reducing overuse improves cost efficiency without the barriers imposed by EI methodology. [Health Affairs 27, no. 4 (2008): w250-w259 (published online 20 May 2008; 10.1377/hlthaff.27.4.w250)]

Key Words: Business Of Health, Physicians, Public Opinion, Health Spending

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