DEA and primary care physician report cards: Deriving preferred practice cones from managed care service concepts and operating strategies

Evaluating the practice patterns of the newly dominant force in managed care, the primary care gatekeeper, will be one of the toughest challenges facing health reformers in the United States. This paper introduces DEA as a tool to profile and evaluate practice patterns of primary care physicians. To illustrate these ideas, the practice behavior of 326 primary care physicians in a large Health Maintenance Organization were studied for one year. When two DEA models were compared, a cone ratio DEA model projected the excess utilization of more hospital days and fewer office visits than a DEA model without defined preferred practice regions. The application demonstrates how a cone ratio DEA model can incorporate strategic thinking and executive accountability when establishing clinical benchmarks.