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Importance: Diagnostic acumen is a fundamental skill in the practice of medicine. Scalable, practical, and objective tools to assess diagnostic performance are lacking., Objective: To validate a new method of assessing diagnostic performance that uses automated techniques to assess physicians' diagnostic performance on brief, open-ended case simulations., Design, Setting, and Participants: Retrospective cohort study of 11 023 unique attempts to solve case simulations on an online software platform, The Human Diagnosis Project (Human Dx). A total of 1738 practicing physicians, residents (internal medicine, family medicine, and emergency medicine), and medical students throughout the United States voluntarily used Human Dx software between January 21, 2016, and January 15, 2017., Main Outcomes and Measures: Internal structure validity was assessed by 3 measures of diagnostic performance: accuracy, efficiency, and a combined score (Diagnostic Acumen Precision Performance [DAPP]). These were each analyzed by level of training. Association with other variables' validity evidence was evaluated by correlating diagnostic performance and affiliation with an institution ranked in the top 25 medical schools by US News and World Report., Results: Data were analyzed for 239 attending physicians, 926 resident physicians, 347 intern physicians, and 226 medical students. Attending physicians had higher mean accuracy scores than medical students (difference, 8.1; 95% CI, 4.2-12.0; P < .001), as did residents (difference, 8.0; 95% CI, 4.8-11.2; P < .001) and interns (difference, 5.9; 95% CI, 2.3-9.6; P < .001). Attending physicians had higher mean efficiency compared with residents (difference, 4.8; 95% CI, 1.8-7.8; P < .001), interns (difference, 5.0; 95% CI, 1.5-8.4; P = .001), and medical students (difference, 5.4; 95% CI, 1.4-9.3; P = .003). Attending physicians also had significantly higher mean DAPP scores than residents (difference, 2.6; 95% CI, 0.0-5.2; P = .05), interns (difference, 3.6; 95% CI, 0.6-6.6; P = .01), and medical students (difference, 6.7; 95% CI, 3.3-10.2; P < .001). Attending physicians affiliated with a US News and World Report-ranked institution had higher mean DAPP scores compared with nonaffiliated attending physicians (80 [95% CI, 77-83] vs 72 [95% CI, 70-74], respectively; P < .001). Resident physicians affiliated with an institution ranked in the top 25 medical schools by US News and World Report also had higher mean DAPP scores compared with nonaffiliated peers (75 [95% CI, 73-77] vs 71 [95% CI, 69-72], respectively; P < .001)., Conclusions and Relevance: The data suggest that diagnostic performance is higher in those with more training and that DAPP scores may be a valid measure to appraise diagnostic performance. This diagnostic assessment tool allows individuals to receive immediate feedback on performance through an openly accessible online platform.

Objective: To assess the level of discounts on glaucoma medications provided by the Medicare prescription drug card program., Methods: We compared the cost of a 1-month supply of 10 brand-name drugs and 1 commonly prescribed combination of drugs purchased at retail cash price, Medicare card-discounted price, and online price. Retail cash prices were collected through a telephone survey of 36 chain pharmacies in 4 states. Card-discounted prices were obtained from an online database updated weekly by Medicare for each drug, drug card, and state in our survey. Prices for drugs purchased online were collected from a leading online drugstore not affiliated with any retail stores that were included in the telephone survey., Results: Card-discounted prices for each drug ranged between 13% and 25% lower on average than retail prices. However, drugs purchased online were cheaper on average than drugs purchased with cards for 7 of the 10 medications surveyed., Conclusions: Drug cards provide significant discounts over retail prices. However, cards may be a secondary option to online purchasing, which may be cheaper and may offer seniors more flexibility to switch between glaucoma therapies. Ophthalmologists can take simple steps to guide seniors to the optimal purchasing option for a given drug in their region.

We used data from the National Practitioner Data Bank (NPDB) to study the growth of physician malpractice payments. Judgments at trial account for 4 percent of all malpractice payments; settlements account for the remaining 96 percent. The average payment grew 52 percent between 1991 and 2003 (4 percent per year) and now exceeds dollar 12 per capita each year. These increases are consistent with increases in the cost of health care. A preoccupation with data on judgments, extreme awards, or specific specialties results in an incomplete understanding of the growth of physician malpractice payments.