Average is Over: Physicians

Important new research from Fletcher, Horwitz and Bradley:

Like teacher value added measures that calculate student test score gains, we estimate physician value added based on changes in health status during the course of a hospitalization. We then tie our measures of physician value added to patient outcomes, including length of hospital stay, total charges, health status at discharge, and readmission. The estimated value added varied substantially across physicians and was highly stable for individual physicians. Patients of physicians in the 75th versus 25th percentile of value added had, on average, shorter length of stay (4.76 vs 5.08 days), lower total costs ($17,811 vs $19,822) and higher discharge health status (8% of a standard deviation). Our findings provide evidence to support a new method of determining physician value added in the context of inpatient care that could have wide applicability across health care setting and in estimating value added of other health care providers (nurses, staff, etc).

As with teacher value-added measures, which I strongly support, the gain here is not simply that we discover who the best teachers and physicians are it’s that by discovering who the best teachers and physicians are we can discover why they are the best–what techniques are they using that others are not? And from there we can begin to scale and apply those techniques more widely.


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