Evaluation of a Physician Peer-Benchmarking Intervention for Practice Variability and Costs for Endovenous Thermal Ablation
Authors: David P. Stonko, Chen Dun, Christi Walsh, Marlin Schul, John Blebea, Edward M. Boyle, Martin A. Makary, Caitlin W. Hicks
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The frequency of use of endovenous thermal ablation (EVTA) to treat chronic venous insufficiency has increased rapidly in the US. Wide variability in EVTA use among physicians has been documented, and standard EVTA rates were defined in the 2017 Medicare database. <h3>Objective</h3> To assess whether providing individualized physician performance reports is associated with reduced variability in EVTA use and cost savings. <h3>Design, Setting, and Participants</h3> This prospective quality improvement study used data from all US Medicare patients aged 18 years or older who underwent at least 1 EVTA between January 1, 2017, and December 31, 2017, and between January 1, 2019, and December 31, 2019. All US physicians who performed at least 11 EVTAs yearly for Medicare patients in 2017 and 2019 were included in the assessment. <h3>Intervention</h3> A performance report comprising individual physician EVTA use per patient with peer-benchmarking data was distributed to all physicians in November 2018. <h3>Main Outcomes and Measures</h3> The mean number of EVTAs performed per patient was calculated for each physician. Physicians who performed 3.4 or more EVTA procedures per patient per year were considered outliers. The change in the number of procedures from 2017 to 2019 was analyzed overall and by inlier and outlier status. An economic analysis was also performed to estimate the cost savings associated with the intervention. <h3>Results</h3> A total of 188 976 patients (102 222 in 2017 and 86 754 in 2019) who had an EVTA performed by 1558 physicians were included in the analysis. The median patient age was 72.2 years (IQR, 67.9-77.8 years); 67.3% of patients were female, and 84.9% were White. Among all physicians, the mean (SD) number of EVTAs per patient decreased from 2017 to 2019 (1.97 [0.85] vs 1.89 [0.77];<i>P</i> &lt; .001). There was a modest decrease in the mean number of EVTAs per patient among inlier physicians (1.83 [0.57] vs 1.78 [0.55];<i>P</i> &lt; .001) and a more substantial decrease among outlier physicians (4.40 [1.01] vs 3.67 [1.41] ;<i>P</i> &lt; .001). Outliers in 2017 consisted of 90 physicians, of whom 71 (78.9%) reduced their EVTA use after the intervention. The number of EVTAs per patient decreased by a mean (SD) of 0.09 (0.46) procedures overall (median, 0.10 procedures [IQR, −0.10 to 0.30 procedures];<i>P</i> &lt; .001). The estimated cost savings associated with the decrease was $6.3 million in 2019. <h3>Conclusions and Relevance</h3> In this quality improvement study, substantial variability in the number of EVTAs performed per patient was observed across the US. When physicians were provided with a 1-time peer-benchmarked performance report card, the timing of the intervention was associated with a significant decrease in the number of EVTAs performed per patient, particularly among outlier physicians. This quality improvement initiative was associated with reduced variability in EVTA use in the US and a substantial savings for Medicare.