Advances in physician profiling: The use of data envelopment analysis

Insurers, health plans, and individual physicians in the United States are facing increasing pressures to reduce costs while maintaining quality. In this study, motivated by our work with a large managed care organization, we use readily available data from its claims database with data envelopment analysis (DEA) to examine physician practices within this organization. Currently the organization evaluates primary care physicians using a profile of 16 disparate ratios involving cost, utilization, and quality. We employed these same factors along with indicators of severity to develop a single, comprehensive measure of physician efficiency through DEA. DEA enabled us to identify a reference set of ‘best practice’ physicians tailored to each inefficient physician. This paper presents a discussion of the selection of model inputs and outputs, the development of the DEA model using a ‘stepwise’ approach, and a sensitivity analysis using superefficiency scores. The stepwise and superefficiency analyses required little extra computation and yielded useful insights into the reasons as to why certain physicians were found to be efficient. This paper demonstrates that DEA has advantages for physician profiling and usefully augments the current ratio-based reports.