The government attempts to compare MDs

July 1, 2005

The Medicare Payment Advisory Commission and the Centers for Medicare & Medicaid Services are considering ways to compare the number and level of services one physician provides against another.

The Medicare Payment Advisory Commission and the Centers for Medicare & Medicaid Services are considering ways to compare the number and level of services one physician provides against another. The goal is to create a confidential ranking that would show individual physicians how efficient they are compared to their peers. The hope is to rein in overutilizers, and therefore control Medicare outpatient spending.

According to American Medical News (5/16/05), the ranking would allow a physician to see, for example, whether he or she used more hospital care to treat patients with emphysema than prescription drugs or home health care, compared to other doctors. The raw data to obtain this information would come from claims submissions, and initially, would not affect Medicare payments. Ultimately, the data could be used to create a national pay-for-performance program.

The American Medical Association warns that rating physicians based on performance on Medicare claims data alone ignores other factors involved in the care of a patient. The claims data may not reflect the severity of the patient's illness or circumstances, nor take into account evolving medical guidelines.