To the Editor: The article by Welch et al. (March 3 issue)1 on physician profiling describes that method well but also illustrates its shortcomings. Adjustment for case mix is the Achilles' heel of physician profiling. All physicians know how flimsy the relation is between actual clinical severity and statistical diagnosis-related groups, not just in individual cases, but for a population as well. Welch et al. omit the age of the Medicare population studied in Oregon as compared with the age of the one studied in Florida. Age alone could explain the difference in utilization found in their study. To the.
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