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GAO recommends profiling physicians to identify inefficiencies

Physician Practice Advisor, March 14, 2007

In an effort to improve the current Medicare physician payment system, the Government Accountability Office (GAO) has recommended that the Centers for Medicare & Medicaid Services (CMS) begin profiling physicians to identify those provide excessive care.

The recommendation comes after a GAO study found primary care physicians in every part of the country that provided more healthcare services than were required to patients. The GAO examined 10 healthcare purchasers with profiling systems to determine whether inefficient physicians could be identified. After identifying inefficient physicians, the purchasers provided incentives to improve efficiency, such as

  • educating physicians to encourage more efficient care
  • designating in physician directories those physicians who met efficiency and quality standards
  • dividing physicians into tiers based on efficiency and giving enrollees financial incentives to see physicians in their particular tiers
  • providing physicians bonuses or imposing penalties based on efficiency and quality standards
  • excluding inefficient physicians from the network

The GAO found that Medicare's data-rich environment is conducive to identifying physicians who are likely to practice medicine inefficiently, and recommended this as a partial solution to Medicare's long-term fiscal instability.

Click here for more information about the GAO study.