Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs

BACKGROUND. Previous research shows patient socioeconomic status (SES) affects physician profiles for health status and satisfaction, but effects on other aspects of care are not known. OBJECTIVE. To examine the effect of patient SES on physician profiles for preventive care, disease management, and diagnostic testing costs. RESEARCH DESIGN. Cross-sectional analysis of a managed care claims data. SUBJECTS. Five hundred sixty-eight physicians and 600,618 patients. MEASURES. Patient age, gender, case-mix, and SES based on zip code, likelihood of having a Papanicolaou smear, mammogram, for diabetics having had a glycosylated hemoglobin, diabetic eye exam, and diagnostic testing costs. RESULTS. For each performance indicator, except glycosylated hemoglobin, there was a statistically significant effect of adjusting for patient SES. For diabetic eye checks, mammograms and Papanicolaou tests respectively, 5%, 16%, and 21% of physicians who were outliers (in the top or bottom 5% of rankings) were no longer outliers after socioeconomic adjustment. For all performance measures the change in physician ranking was strongly correlated with the mean practice SES. CONCLUSIONS. Patient SES, as measured by zip code, appreciably affects physician profiles for preventive care and diabetes management. Monitoring patient SES using patient zip codes could be used to target resources to improve outcomes for higher risk patients.