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Original Investigation
August 2015

Index to Estimate the Efficiency of an Ophthalmic Practice

Author Affiliations
  • 1Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles
  • 2Paul Merage School of Business, University of California, Irvine
  • 3Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
JAMA Ophthalmol. 2015;133(8):924-929. doi:10.1001/jamaophthalmol.2015.1447

Importance  A metric of efficiency, a function of the ratio of quality to cost per patient, will allow the health care system to better measure the impact of specific reforms and compare the effectiveness of each.

Objective  To develop and evaluate an efficiency index that estimates the performance of an ophthalmologist’s practice as a function of cost, number of patients receiving care, and quality of care.

Design, Setting, and Participants  Retrospective review of 36 ophthalmology subspecialty practices from October 2011 to September 2012 at a university-based eye institute.

Exposures  The efficiency index (E) was defined as a function of adjusted number of patients (Na), total practice adjusted costs (Ca), and a preliminary measure of quality (Q). Constant b limits E between 0 and 1. Constant y modifies the influence of Q on E. Relative value units and geographic cost indices determined by the Centers for Medicare and Medicaid for 2012 were used to calculate adjusted costs. The efficiency index is expressed as the following: E = b(Na/Ca)Qy. Independent, masked auditors reviewed 20 random patient medical records for each practice and filled out 3 questionnaires to obtain a process-based quality measure.

Main Outcomes and Measures  The adjusted number of patients, adjusted costs, quality, and efficiency index were calculated for 36 ophthalmology subspecialties.

Results  The median adjusted number of patients was 5516 (interquartile range, 3450-11 863), the median adjusted cost was 1.34 (interquartile range, 0.99-1.96), the median quality was 0.89 (interquartile range, 0.79-0.91), and the median value of the efficiency index was 0.26 (interquartile range, 0.08-0.42).

Conclusions and Relevance  The described efficiency index is a metric that provides a broad overview of performance for a variety of ophthalmology specialties as estimated by resources used and a preliminary measure of quality of care provided. The results of the efficiency index could be used in future investigations to determine its sensitivity to detect the impact of interventions on a practice such as training modules or practice restructuring.