CMS Seeks To Begin 'Profiling' Inefficient Physicians

Main Category: Primary Care / General Practice
Article Date: 15 May 2007 - 13:00 PDT

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CMS has the data and computer capacity to identify physicians who are inefficient compared with their colleagues and as early as mid-2008 might begin to contact those physicians and ask them to become more efficient, Herbert Kuhn, acting deputy administrator of the agency testified on Thursday at a House subcommittee hearing, CQ HealthBeat reports. At a House Ways and Means Subcommittee on Health hearing, Kuhn said that identification of inefficient physicians, or "profiling," would involve a comparison of the number of tests ordered by physicians for certain types of patients with the number ordered by colleagues in cases that have the same outcome.

Kuhn said that the largest concern about implementation of profiling involves the determination of how to use the results to educate physicians to become more efficient and whether to involve medical societies, Medicare quality improvement organizations or other groups in the process. He added that he expects CMS to implement profiling on a "broad scale" and target as many physicians as possible, "if not all physicians." In addition, Kuhn said that CMS could implement profiling without the passage of legislation.

Bruce Steinwald, director of health care at the Government Accountability Office, said that profiling would reduce costs for Medicare, although the practice would require additional funds for CMS. He added that the ability of profiling to reduce costs for Medicare requires a link between the practice and reimbursement rates, a move that likely would require the passage of legislation. Kuhn said profiling is "an ambitious goal," adding, "I think we need to set ambitious goals if we're moving forward in this important reform area."

Other Testimony
Anmol Mahal, president of the California Medical Association, said that California physicians support the education of physicians to become more efficient but added that CMS first should test a link between profiling and Medicare reimbursement rates with a pilot program. In addition, John Mayer, president of the Society of Thoracic Surgeons, raised concerns about whether CMS has the ability to compare the efficiency of physicians accurately (Reichard, CQ HealthBeat, 5/10).

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