PHYSICIANS RESPONSE TO LENGTH-OF-STAY PROFILING

One of the techniques adopted recently by certain hospitals to meet th e competitive pressure for reducing costs is physician profiling. Prof iling produces periodic reports that compare a physician's resource co nsumption to a benchmark figure. This study analyzes the effectiveness and implications of one hospital's introduction of physician patient length-of-stay profiling. Data for 24,000 patients treated by 400 phys icians in 450 diagnosis-related groups over 42 months were analyzed, i ncluding both preprofiling and post-profiling periods. Statistical tes ts examined whether more physicians achieved the length-of-stay benchm ark after profiling was introduced, controlling for physician, disease category (diagnosis-related group), and patient severity level. First , the results establish a significant increase in the percentage of ph ysicians who achieve the length-of-stay benchmark after the introducti on of profiling. Second, it was found that physicians who had initiall y failed to meet the benchmark reduced their patients' average length of stay much more than those physicians who initially achieved the ben chmark. Further, reductions occurred primarily at intermediate severit y levels, and in diagnosis-related groups with a large economic impact for the hospital. Although the profiling program did achieve the obje ctive of reducing patient length of stay, further improvement may be p ossible. First, providing different benchmarks or targets for differen t physicians may extend the improvement to a greater percentage of all physicians involved. Second, an analysis of monthly data on total wei ghted procedures reveals that the reduction in length of stay resulted in an increase in the number of procedures performed per patient day. This finding suggests that to achieve a reduction in hospital costs a nd charges, profiling programs should be combined with process improve ment initiatives.