Who Determines Physician Effectiveness?

Abstract

It is a paradox. Although physicians do not control patient behavior, physician effectiveness is increasingly determined by patient behavior. There is a trend toward physician ratings being based on specific metrics related to the management of chronic illness. Such markers include glycosylated hemoglobin levels, blood pressure, body mass index, and smoking rates, along with other factors known to affect risk of morbidity and mortality. However, the physician contribution to changing the actual outcomes is limited.Population analyses of health outcomes suggest that medical care accounts for only 10% of the variance in outcomes, whereas approximately 50% can be attributed to behavioral and social factors.1 With respect to the chronic conditions that receive the largest proportion of health care attention, such as cardiovascular disease and diabetes, physicians identify risk factors,

The Medicare Hospital Readmissions Reduction Program

“…A policy that does not consider other important factors in patients' lives is fundamentally unwise, and likely not to be effective over time. 6 Hospitals should not be penalized simply because of the demographic characteristics of their patients. However, the evidence indicates that HRRP is doing exactly that, penalizing the safety-net institutions that provide care for patients who otherwise would struggle to find care.…”

The Challenges of Measuring, Improving, and Reporting Quality in Primary Care

“…In contrast, complex adaptive systems have no single point of control. 5 Input variables for primary care processes and health outcomes are often beyond the control of the physician and patient, 25 such as socioeconomic factors 26 and poverty. 27 Some successes in hot spots of improving care for disadvantaged populations 28 may be generalizable, but the improved outcomes of these programs were more likely achieved by creating care plans adapted to the unique circumstances of high-risk patients.…”

Building an Engineering-Based Medical College: Is the Timing Ripe for the Picking?

“…For example, population studies estimated that medical care contribute only about 10 % of the variance in the final outcome of health, whereas a huge percentage (50 %) of the outcome is dependent on behavior and social factors [12]. Yet physicians are playing little role in the other factors.…”