Provider profiling: What works for medicine works for mental health?

Abstract

Provider profiling is a growing practice in organizations that supply or pay for health care, and escalating health care costs are likely to accelerate this trend. First developed for general medical settings, profiling systems now challenge practicing psychologists to meet ostensibly objective, scientific standards of care.The most advanced approaches compare provideis on a "level playing field" statistically adjusted for variations in the "illness burden" of their patients. Profiling psychological practice, however, requires specialized new tools and more sophisticated analytical methods than have typically been used. This article provides a practical overview of provider profiling, emphasizing related developments in health care policy that are perhaps less familiar to practicing psychologists. Potential pitfalls confronting professional psychology are discussed, and points for advocacy are suggested.Escalating costs of health services have fostered the rapid proliferation of managed care. In turn, the growth of managed care has led to the routine, intensive scrutiny of provider practice patterns as a primary cost-containment strategy-a strategy that has fundamentally altered the provider-payer relationship (Physician Payment Review Commission, 1992). Although the debate over provider profiling has focused on applications in primary and general medical practice, psychologists, psychiatrists, and other mental health practitioners are nonetheless subject to the same economic and competitive pressures that have inspired vigilant attention to others' behavior. As with many influential developments in health care policy and practice, however, profiling has received scant attention in the mental health professional literature.The motivations underlying profiling and the ways in which it has been implemented and interpreted have important ramifications for the mental health community, both as matters of public policy and as private concerns of individual practitioners. As programs to track services become more sophisticated, the poten-JAMES N. BRECKENIUDGE received his PhD from the University of Houston.

Diagnostic Cost Groups (DCGs) and Concurrent Utilization among Patients with Substance Abuse Disorders

“…1999; Frank etal. 1997; Hendryx, Dyck, and Srebnik 1999; Breckenridge 2000). These population‐based „case‐mix tools” are increasingly being adopted by health care organizations.…”

“…Diagnosis-based risk adjustment systems are widely used to predict resource utilization, provide population-based health management, and make equitable comparisons across providers and facilities (Ettner and Notman 1997;Ettner et al 1998;Ettner, Frank et al 1999;Frank et al 1997;Hendryx, Dyck, and Srebnik 1999;Breckenridge 2000). These population-based ''case-mix tools'' are increasingly being adopted by health care organizations.…”