AMA Guidelines for Reporting Physician Data
Nearly every major health care payer sponsors a physician profiling program that provides physicians with data that can be used to influence physician behavior and decision-making and facilitate practice improvements. The AMA recognizes the importance of providing performance information to physicians so that they can verify the accuracy of profiling results, especially when these data are used as the basis for pay-for-performance, tiered networks, narrow networks and/or public reporting systems. These data reports can also serve as another valuable source of information to support physicians in data-driven decision-making.
Multiple barriers currently prevent physicians from effectively using the data in these reports. Physicians may have difficulty understanding complex performance data and analytic methodologies used in creating these forms. The utility of existing data reports is also limited by the lack of aggregated claims data from all sources, including Medicare and Medicaid. However, payers could make three improvements in data reports that would assist physicians in being able to better understand and use their performance data:
- Greater industry-wide standardization of the reporting format
- Greater transparency of the processes used to create the report
- Adequate depth of data available to physicians including patient-specific data
In an effort to support these improvements in physician data reporting, the AMA, in consultation with many physicians, Federation of Medicine staff, national health insurers, accreditation bodies and others, has created the Guidelines for Reporting Physician Data (Reporting Guidelines). The Reporting Guidelines are intended to be aspirational goals that will encourage health plans and other reporting bodies to standardize the format used for physician data reporting and provide physicians with patient-level detail to enhance the utility of data reports. The implementation of the Reporting Guidelines will enhance the effectiveness of the reports and increase physician understanding and use of the data. Developing data reports in accordance with these Reporting Guidelines will thus mutually support physicians and payers.
More than 60 organizations have pledged support for the use of the Reporting Guidelines to create data reports that physicians can easily understand and use to enhance data-driven decision-making. In a letter announcing their release, AMA CEO Dr. James Madara urged all interested stakeholders to formally affirm their support for the Guidelines. Please contact Heather McComas, Senior Policy Analyst, if you have any questions about the Reporting Guidelines.