Physician Efficiency & Quality Data
The rising cost of health care leads health insurers, employers and government-run plans to explore ways to reduce spending and increase the value of their health care expenditures. Using performance data and metrics to develop physician networks and steer patients toward less costly care is a common, industry-wide practice. At the same time, performance data can also be a powerful tool for physicians who seek to increase the quality and efficiency of their care. Use the resources and tools provided by the AMA to understand how to use your practice data to maximize your position in the evolving health care marketplace.
The AMA continues to encourage health insurers to improve the accuracy and transparency of their reporting practices. The AMA also provides tools that help physicians take an active role in reviewing their practice data, appealing inaccurate results and engaging in performance improvement activities. Learn more about how the AMA works to:
- improve the accuracy and utility of performance data
- provide steps physicians can take to understand their data and use it to improve quality and efficiency
- reduce the likelihood of audits
- ensure the fair ranking of physician practices
The AMA believes that any measurement of a physician’s performance must include an accurate assessment of care quality, not just its cost, in order to fairly represent the value of a physician’s care. We encourage all insurers to evaluate quality in their practice ranking programs and to use standard quality measures which have been endorsed by national measure development organizations (e.g., the Physician Consortium for Performance Improvement, the National Quality Forum or national medical specialty societies). Learn more about how the AMA contributes to the national push for quality measurement that truly reflects the quality of care given.
Private and public payers use the physician data that they collect to create “profiles” of physicians regarding the quality and cost of the medical care they provide – often using the profile to rank or rate the physicians. The AMA is committed to helping physicians understand profiling methodology and to working with insurers to improve the accuracy and transparency of profiling programs.
Through physician profiling systems, insurers create tiered and narrow networks to control resource use and steer patients towards less costly providers.
- Tiering: Insurers rank physicians and place them into tiers based on cost; patients are encouraged (often through reduced co-pays) to use physicians in the least expensive tier
- Narrow networks: Insurers require patients to use a small group of lower-cost physicians
Learn more about tiering, narrow networks and the AMA’s advocacy efforts in this area.