Clinical integrity toolkit
The Clinical Integrity Toolkit contains various resources to aid the physician practice and their staff in developing strategies for influencing payers to make policies fair and clinically appropriate.
Pay for performance: A Physician's Guide to Evaluating Incentive Plans (PDF) contains a series of questions and observations that can be useful in looking at common properties of pay for performance and other physician incentive programs.
Physician Pay For Performance Initiatives (PDF), developed by AMA staff, takes a dispassionate but critical look at PFP programs and asks a series of questions about the potential impact that program components can have on patients and physicians. This piece is intended to be informational and does not reflect the official position of the AMA in regards to PFP.
Economic Profiling of Physicians: What is it? How is it Done? What are the issues? (PDF)
Economic Profiling of Physicians: What is it? (PDF)
As an expert consultant to the AMA, J. William Thomas, PhD, has written a ten-page paper explaining in detail the process health plans use to profile physicians on cost. For those who prefer brevity, and abbreviated version is also available.
How to Challenge Your 'Profile' or Placement in a Tiered or Narrow Network (PDF), created by Physician Practice Advocacy, offers physicians seven steps to follow when challenging their network placement with insurers. These steps mirror the problems physicians have identified with these types of programs, i.e., the use of claims data, inadequate risk adjustment, lack of an appeal mechanism and invalid ratings.
Patient registries
Optimizing outcomes and pay for performance: Can patient registries help? (PDF) dicusses the pros and cons of implementing patient registry systems.
AMA analyses of health insurers' Physician Profiling Programs
The AMA has recently studied UnitedHealthcare’s “Premium Designation” program and Wellmark’s “Incent and Reward Best Practices” program in great detail and had discussions with physicians participating in these programs. From these discussions, as well as from extensive research of public information, the AMA has constructed charts that analyze how components of these two programs compare with the five AMA Principles for Pay for Performance Programs. Each chart has been reviewed by the respective health insurer.
The charts are presented so that physicians can effectively analyze and identify problems and positive practices for each program. It is anticipated that this type of comparison can be used by individual physicians and physician practices in their managed care contracting activities and by AMA and the Federation to influence change in the design of programs utilizing physician profiling. It is anticipated that additional analyses/reports of other major physician profiling programs will be prepared in the future.
