Insurers using more physician profiling, delegates told

Payers push to measure physician efficiency, but experts say economic profiling can be inaccurate.

By Kevin B. O'Reilly, AMNews staff. July 10, 2006.

Chicago -- Insurers increasingly are profiling doctors on how cost-effectively they provide care despite major methodological limitations, a panel told delegates at the American Medical Association Annual Meeting in June.

Physician profiling by private health plans is happening right now, Nancy Nielsen, MD, speaker of the AMA House of Delegates, who moderated the panel of experts, told physicians who attended a session, "Efficiency Measures: Necessary, Necessary Evil, or Just Evil? The Centers for Medicare & Medicaid Services also is pilot-testing privately developed physician efficiency measures.

Just because physicians might be unaware of the profiling "doesn't mean it's not being used to calculate your efficiency," Dr. Nielsen said.

Reasons for the increased use of efficiency measures are pretty straightforward, the experts said. The doubling of health care costs since 1999 and Medicare's impending insolvency in 2018 have created new professional duties for physicians to keep an eye on costs, said Troyen Brennan, MD, MPH, Aetna's chief medical officer.

"The more we spend per capita on health care, the more people lose insurance," Dr. Brennan said. "The more we provide for each individual patient, the more we actually deprive other patients who won't be able to access care at all. It's a problem for government, it's a problem for individual employers and it's a problem for physicians, because there's a whole host of patients who have no access to care."