What is Public Reporting of Physician Performance?
Many payers publish physician performance data on cost, quality and patient experience. This data often comes from various sources, including patient surveys, claims and other clinical and administrative data. It is then aggregated and presented in a format that is accessible to the public.
The public reporting of physician performance offers one way to compare physician practice patterns across various dimensions of cost, quality and patient experience. This increased transparency of data empowers consumers and other stakeholders to consider the performance of physicians on specified measures as they decide which physicians to work with.
The Centers for Medicare and Medicaid Services (CMS) publishes this type of data on its Medicare “Care Compare” website. Private payers also publish physician performance data through their own programs.
However, public reporting of physician performance is a complex issue that requires careful consideration of potential benefits and risks.
What Are Some Risks?
- Data Accuracy and Reliability: All data comes with limitations. Inaccurate or unreliable data can misrepresent a physician or group’s performance.
- Misinterpretation: Patients may not fully understand the intricacies of the reported performance measures or how they relate to the quality of care. This may cause them to misinterpret that data.
- Unfair Effects on Physician Reputation: Performance on some metrics may be due to factors beyond a physician’s control such as resource limitations or factors related to the population they serve.
- Resource Burden: Collecting, analyzing and reporting performance data can be resource-intensive for physician practices, which can shift the focus away from patient care and quality improvement efforts.
How It Should Not Be Used?
While useful for comparative purposes, this physician performance data should not be used as a comprehensive assessment of physician quality. It also should not be used to determine the quality of care provided to individual patients or as a measure of the overall quality provided by individual physicians.
This is because the data is limited to a small subset of the overall patient population cared for by the physician or physician group. It may not be risk-adjusted, and it may only include some measures of quality. Furthermore, it reflects only the care that is easily documented in discrete data fields of the physician’s electronic health record and not the true, comprehensive quality of all care provided.
Public reporting of physician performance also cannot be used to address issues of physician competency, including the dimensions of medical knowledge, skills and competence. Such issues should be addressed by the appropriate public and private credentialing bodies.
Guidelines
Public reporting of physician performance should be consistent with the American Academy of Family Physicians (AAFP) Performance Measures Criteria. Payer programs should weigh the value of the physician performance reporting against the administrative burden that it places on physicians to collect and report the data. Programs should also adhere to the following principles:
Data Accuracy and Timeliness
- Describe clearly the limitations of the data they publish.
- Disclose the data’s source, as well as provide a specific window of time for which the data reflects performance. Data should be as recent as is feasible to publish.
- Report clearly on the validity, accuracy and reliability of data utilized:
- Detail the steps taken to ensure data accuracy and fair physician attribution of costs of care,
- Define clearly the peer group against which individual physician performance is measured/compared,
- Disclose data limitations, e.g., patient choice, actions of other clinicians or the completeness and representativeness of data,
- Describe the attribution methodology and level of attribution of patient populations to either individual or physician groupings,
- Ensure measurement is evidence-based, reliable and valid,
- Use appropriate risk adjustment in measurement ando
- Establish and report data using meaningful time periods for data collection.
- Define clearly what is being measured, how performance scores are calculated and how those scores are compared to peers.
- Utilize criteria for comparison purposes based on valid peer groups, evidence-based statistical norms and/or evidence-based clinical policies.
Patients/Consumer-facing Data
- Describe explicitly all data limitations in lay terms that are easy to understand.
- Detail whether the data reflects the performance of an entire physician group or an individual physician.
- Provide consumers with adequate interpretive physician performance data guidance.
Physicians and Other Clinician Involvement
- Involve physicians in the selection of performance measures as well as the development of feedback and appeals processes.
- Include actionable measures that allow physicians to implement improvements.
- Eliminate or minimize the administrative burden of data collection and reporting to payers.
- Provide an opportunity for physicians to review their performance profiles prior to publication. Payers should establish and communicate a reasonable, formalized reconsideration process in which physicians can appeal their performance rating/designation(s). This process includes providing:
- A minimum of 90 days for physicians to review, validate and appeal their payer’s performance report before public reporting,
- The opportunity to submit exclusions for specific patients who are not receiving indicated clinical interventions based on best practices, and
- An immediate adjustment of physicians’ performance rating/designation(s) based upon a successful reconsideration or discovery of errors in the payer’s data.
When possible, public reporting programs should participate in a centralized, all-payer performance data dashboard accessible to consumers, providers, payers and other stakeholders.
(1999) (December 2024 BOD)