Document Detail


Benchmarking medical group practices using claims data: methodological and practical problems.
MedLine Citation:
PMID:  11067095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
As claims data for physicians and groups of physicians has improved in quality and quantity, health information vendors have begun marketing information about medical groups' productivity, utilization, and quality. Based on interviews with product developers and our understanding of the evolution of their products, several methodological and practical issues remain. For now and the immediate future, health information vendors will continue to face the limitations of physicians' claims data. Vendors and purchasers should be aware of common data shortcomings such as inadequate monthly enrollment figures, possible physician upcoding to circumvent utilization management restrictions, and incorrect coding when a test is used to rule out a disease. In the longer term, several avenues seem likely to make medical groups' data better and richer because of computer-based medical records and efficiencies possible from the Internet. The field of benchmarking products for group practices is still an immature market. However, several trends suggest such products are highly desirable. Provider organizations which bear medical risk need benchmarking data to help improve their efficiency. There are many important nonprovider organizations that need good information on group practices' utilization patterns and outcomes to help them plan new products and negotiate with physicians.
Authors:
H G Dove; B R Greene
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of ambulatory care management     Volume:  23     ISSN:  0148-9917     ISO Abbreviation:  J Ambul Care Manage     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-12     Completed Date:  2000-10-12     Revised Date:  2002-10-29    
Medline Journal Info:
Nlm Unique ID:  7802876     Medline TA:  J Ambul Care Manage     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  67-77     Citation Subset:  H    
Affiliation:
Department of Health Policy and Administration, Yale University, New Haven, Connecticut, USA.
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MeSH Terms
Descriptor/Qualifier:
Benchmarking / methods*
Contract Services
Data Collection / standards
Data Interpretation, Statistical
Efficiency
Group Practice / standards*,  utilization*
Physicians / classification
Severity of Illness Index
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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