At CHIBE, we've recently begun studying how providing physicians with transparent feedback on their performance in comparison to peers could encourage high-value practices. There are a number of reasons why peer comparisons among physicians may be a good idea. First, they align with professional values - which are explicitly articulated for physicians in the Hippocratic Oath and charters from professional societies. Second, they can be a component of promoting a culture of transparency, which is a growing trend across medicine and healthcare. Third, peer comparisons provide physicians with informative feedback on how they practice relative to other physicians. 

 

Medicare recently started providing practice-level, transparent, comparative feedback under its new cancer payment model (the Oncology Care Model); the trend toward peer comparisons is already underway. However, before leaders start unrolling report cards and dashboards filled with comparative data, we must be mindful that studies outside of health care show that how a comparison is designed can greatly affect the type of behavior change it elicits. For example, providing employees with information on how much their colleagues were saving for retirement paradoxically decreased the amount that each employee saved. There are several dimensions to consider when making peer comparisons, including the framing of feedback and the focus of behavior change. These elements need further study before health care systems start deploying this practice as an intervention writ large.