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January 5, 2000, Vol 283, No. 1 >

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Letters | January 5, 2000

Unreliability of Physician "Report Cards" to Assess Cost and Quality of Care

John E. Wennberg, MD
JAMA. 2000;283(1):51-54. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-1-jbk0500.
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To the Editor: Dr Hofer and colleagues1 find that physician profiling to assess individual performance with regard to hospitalization and visit rates is unproductive and can have unintended consequences. As they show, individual physician practice patterns within each of their 3 study sites are difficult to detect and likely to have limited effect. However, an additional result that is not remarked on in the article is the wide variation in the average rates of use across the 3 sites. The percentage of patients with diabetes who were hospitalized more than once ranged from 8% to 17%, and the average number of outpatient visits varied from 8.8 to 11.9 even after carefully controlling for sociodemographic and case-mix factors (their Table 2). That this amount of variation in practice styles exists is striking and a strong confirmation of findings from small-area studies.2

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