Physician Profiling
New AMA Policy on the Use and Release of Physician Data
At its June 2009 Annual Meeting, the AMA House of Delegates approved the Principles for the Public Release and Accurate Use of Physician Data and policy regarding the Release of Claims and Payment Data from Government Health Care Programs.
New AMA resources help physicians understand risk assessment and adjustment models
âAn introduction to risk assessment and risk adjustment modelsâ (PDF) defines the terms ârisk assessmentâ and ârisk adjustmentâ and provides overviews of the prominent risk assessment and risk adjustment models and their various uses, including profiling physicians and other health care professionals. A second resource, âTerminology used in physician profilingâ (PDF) helps physicians assess information they receive about physician profiling programs by defining common profiling terms used in health insurersâ physician profiling programs.
Value, accuracy and transparency in physician profiling programs: A comparison of four physician profiling documents
As part of the AMAâs continuing effort to promote value, accuracy and transparency in physician profiling programs, we have compiled a chart (PDF) comparing the major components of four profiling programs.
AMA analyses of health insurers' physician profiling programs
The AMA has constructed charts that analyze how components of the following five programs compare with the five AMA Principles for Pay for Performance Programs. Each of the charts has been reviewed by the respective insurer. The charts are presented so that physicians can effectively analyze and identify problems and positive practices for each program.
CIGNA Care Designation program (CCD) (PDF)
CMS Physician Quality Reporting program (PQRI) (PDF)
UnitedHealthcare's "Premium Designation" program (PDF)
Wellmark's "Incent and Reward Best Practices" program (PDF)
Aetna's "Aexcel" Program (PDF)
Physician Profiling: How to prepare your practice (PDF)
This flyer is the companion to the first physician profiling flyer, How to Challenge Your 'Profile' or Placement in a Tiered or Narrow Network, and offers five steps for physician practices to follow to prepare for insurers' profiling programs. These steps encompass the basic elements of the physician profiling process, i.e., contract language, program metrics, data, coding, and patient education.
New AMA survey highlights need to improve Medicare's PQRI
AMA press release
Physician Profiling poster
This poster explains some of the problems associated with physician profiling programs and is designed for display in your patient reception room.
See a copy of the poster (PDF).
Order your free poster now.
Tiered and narrow physician networks (PDF)
Learn how health plans and other payers are profiling you by applying analytical software programs to their claim data. This booklet explains the episode grouper process that insurers use to profile physicians for network replacement and provides a sampling of some tiered and narrow networks that are currently in operation.
How to Challenge Your 'Profile' or Placement in a Tiered or Narrow Network (PDF)
This resource 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.
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.
