Gainesville, FL, USA: University of Florida.
University of Florida, Gainesville, FL, USA
Provider profiling use epidemiological methods to compare physician practice patterns across various dimensions of care. These dimensions of care may include length of stay, procedures ordered or cost per diagnosis – related group (DRG). The premise behind provider profiling is that physicians with appropriate information will change the way they practice in order to conform to acceptable guidelines thereby improving the quality of care. Increasingly, managed care organizations and other delivery entities are using provider profiling as a means to understand and control costs.
This report provides the Agency for Health Care Administration (AHCA) with important conclusions made from reviewing literature regarding provider profiling programs. Findings from interviews with key informants, state Medicaid agency officials, and physicians are also provided to highlight the important conclusions and implications of implementing provider profiles.
Specifically, areas of concern for the current AdvancedMed profiling system used by AHCA would be the time lags associated with data used to compile provider profiles, the current configuration of reports and its usefulness for providers, and the level of input Medicaid physicians have on the design and implementation of the provider profiling program. As AHCA considers the implementation of provider profiles within its Medicaid program, the following guidelines are critical to assuring some level of success:
• The initial emphasis should be on quality improvement
• Performance measures should be clinically important
• Accountability for performance should be limited to patients and services for which physician is directly responsible
• Adequate risk and case mix adjustment must be incorporated in the program design with accompanying explanation of how data was adjusted
• Physicians should be involved early in the design and implementation of provider profiling strategies in order to generate ‘buy-in’
• Performance reports should be clear and easy to understand and coupled with provider feedback and educational opportunities
• Provider profiling programs should make every attempt to use accurate data
Please log in/register to access.