Medicare could start comparing resource use among doctors in 2008

A GAO report prompts warnings from physicians against the government using the information to penalize doctors deemed "overutilizers."

By David Glendinning, AMNews staff. June 25, 2007.

Washington -- Until recently, the concept of Medicare gauging how efficiently physicians provide care under the program was largely theoretical. But the Government Accountability Office now thinks the Bush administration could make the leap from theory to practice as early as next year.

In a recent report and testimony to Congress, the GAO said Medicare resource use comparison, also known by the more ominous term "physician profiling," could be ready to go live by the middle of 2008. By combing through Medicare claims and compiling utilization statistics for individual physicians and groups, the Centers for Medicare & Medicaid Services could determine how doctors compare with each other when it comes to volume and intensity of services.

CMS then could send doctors and physician groups reports that give them a sense of how much care they provide for particular patient conditions in relation to their colleagues. For instance, a physician might realize that he or she bills far more complex office visits for diabetes patients than do other doctors in the area. This could spur the physician to shift treatment patterns to match his or her peers more closely.

Federal officials hope that Medicare will save money in the long run by convincing doctors who bill for a relatively large volume of services to be more judicious in how much care they order. But CMS has not yet determined if or when it will implement such an initiative.

Resource use comparison is not a new concept. The Medicare Payment Advisory Commission, which recommends reimbursement policies both to Congress and the administration, for years has said CMS should use its administrative authority to start making these comparisons.