Medicare Has Data Conducive To Identifying Inefficient Physicians, Says GAO
May 14th, 2007
The Centers for Medicare and Medicaid Services (CMS) has the tools and claims data necessary to evaluate physicians’ practice patterns as a vehicle for improving the efficiency of the services delivered under the Medicare program, A. Bruce Steinwald of the Government Accountability Office (GAO) told a House panel May 10.
His testimony before the House Ways and Means Subcommittee on Health draws from a recent GAO report on physician profiling—Medicare: Providing Systematic Feedback to Physicians on Their Practice Patterns Is a Promising Step Toward Encouraging Program Efficiency (GAO-07-862T).
Witnesses at the hearing discussed various strategies to address the growth in volume and intensity of physician services under Medicare.
Linking efficiency to Medicare’s physician payment policy has attracted much attention of late as a way to address flaws in the current system based on the much-criticized Sustainable Growth Rate (SGR) formula, Steinwald said.
“A primary virtue of profiling is that, coupled with incentives to encourage efficiency, it can create a system that operates at the individual physician level,” unlike the SGR which operates in the aggregate, Steinwald told the panel.
According to Steinwald, Medicare already has a comprehensive repository of claims data to use in computing reliable efficiency measures, as well as “substantial experience adjusting for differences in patients’ health status.”
“Medicare’s data-rich environment is conducive to identifying physicians who are likely to practice medicine inefficiently,” Steinwald noted.
Moreover, CMS is well-versed in conducting educational outreach to physicians on improper practices and potential fraud.
“A physician education effort based on efficiency profiling would therefore not be a foreign concept in Medicare,” Steinwald said.
Also testifying at the hearing, CMS Acting Deputy Administrator Herb Kuhn said measuring “physician resource use in Medicare will be an ambitious undertaking.”
Developing a system that measures physician resource use will be a multi-year, multi-step process, Kuhn noted. But added that appropriately measuring physician resource use and communicating that information to physicians has “much potential.”
Medicare is at the beginning of a long process, Kuhn added. “As the possibilities and limitations of our data are better understood and measurement issues are sorted through, an assessment can be made about specialties, services or physicians for which resource use is most promising.”
View more information about the hearing.
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