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There is an unspoken assumption that the quality of a physician's output is not affected by pressure to contain costs and improve efficiency. However, in most cases, outcome studies have not been designed or performed that examine this assumption. Skin biopsy reports from managed care–directed laboratories received during 1995 have been collected.¹ Reports for 1997 were collected prospectively until the sample size was equal to that of 1995. Text comprising the gross and microscopic descriptions in each report was quantified. The Mann-Whitney test determined if a significant change in text volume had occurred.

Table 1 illustrates a significant decrease in the text used to describe both gross and microscopic features (P<.001 for both studied parameters) in reports received in 1997 when compared with those in 1995. The most common microscopic descriptions in 1997 were "microscopic findings support the above (cited) diagnosis" and no histological description, which were found . . . [Full Text of this Article]