Physician profiling could save Medicare dollars, CMS says

CMS may join the ranks of the private insurance industry by using a "profiling" method to monitor physician use of Medicare resources. Docs whose patients overuse Medicare resources needlessly could receive direct, confidential feedback from CMS, according to a new study released by the Government Accounting Office.

The GAO focused its analysis on four specialties--cardiology, diagnostic radiology, internal medicine, and orthopedic surgery. Using 2005 and 2006 Medicare claims data, GAO found that these specialists showed "considerable stability" in resource use despite high patient turnover. The stability suggests that a per capita resource use might be a reasonable way to profile specialists because it reflects distinct patterns of a physician's resource use, rather than the particular population of his or her patients.

CMS agreed with the assessment, and says it favors the development of a "physician feedback system" that would also incorporate episode-based resource use and quality measures.

"Given the role of physicians in total Medicare spending, there are opportunities to increase the efficiency of the Medicare program by measuring and reporting in physician resource use," wrote Charlene Frizerra, CMS' acting administrator.

To learn more about profiling:
- read the full report

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