Physician Characteristics and Associations with Quality of Care

Some health plans encourage their members to choose physicians who provide high-quality care, but most patients do not have access to physician quality measures. The Agency for Healthcare Research and Quality advises patients to consult state medical boards and gather information on training and board certification as a way to evaluate quality of care provided. Healthgrades.com gives “recognized doctor” and “5-star doctor” designations to physicians who are board certified, have never had their license revoked, and are free of disciplinary actions or malpractice claims. The value of these publicly available physician characteristics is unclear. Researchers recently examined the relationship between physician characteristics and performance on a broad range of quality measures. They reported results in Archives of Internal Medicine [2010;170(16):1442-1449]. Scores for physician performance were determined using a deidentified aggregated claims data set of 1.3 million patients ages 18 to 65 years who were continuously enrolled in 1 of 4 commercial health plans in Massachusetts in 2004-2005. In combination, the 4 plans accounted for >85% of the commercial market in the state. All professional, inpatient, facility, and pharmaceutical claims were included in the data set. Physicians were linked across the 4 plans using an instrument developed by the Massachusetts Health Quality Partners, connecting a unique physician identifier to the healthcare provider numbers used by each health plan. The researchers obtained publicly available data on individual physician characteristics from the Massachusetts Board of Registration in Medicine. The information included birth date, medical school graduation date, medical school attended, board certification status, sex, payment on malpractice claims, and disciplinary actions. After applying exclusion criteria to the database of healthcare providers who have a contract with any of the major commercial health plans in Massachusetts, there were 10,408 physicians in 23 specialties included in the analysis. The researchers used the RAND claims-based Quality Assessment Tools to assess performance on measures of clinical quality. The analysis included 1,704,686 quality measure opportunities, a mean of 163.8 events per physician. The majority of the physicians were male (70.1%), board certified (92.8%), trained in the United States (83.0%), and in possession of allopathic medical degrees (97.7%). Years in practice ranged from <10 (15.2%) to ≥30 (24.7%). Only 10.2% had made payments on malpractice claims in the past 10 years and 1.0% had disciplinary actions against them. One in 10 attended a medical school ranked in the top 10 by US News & World Report. While there were 23 specialties represented, 34.5% of the physicians in the analysis practiced internal medicine. Overall, mean unadjusted performance score was 62.5%. The 5th to 95th percentile range was 48.2% to 74.9%. The performance scores varied by condition: 30.9% for cataract care to 68.0% for congestive heart failure care. There were 3 physician characteristics independently associated with significantly higher overall performance: female sex (1.6% higher than male sex; P<.001), board certification (3.3 percentage points higher than noncertified; P<.001), and graduation from a domestic medical school (1.0 percentage point higher than international; P<.001). There was no significant association between performance and malpractice claims. In conclusion, the researchers said “few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.”