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Profiling physicians may help identify inefficiencies, says GAO

Ambulatory Surgery Reimbursement Update, March 20, 2007

The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) begin profiling physicians to identify those physicians that provide excessive care.

The GAO made the recommendation in an effort to improve the current Medicare physician payment system, according to a new report from the GAO on testimony provided by the GAO before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives

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.

To learn more information about the GAO study, click here.

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