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AMA: Fold IT Tools Into Physician Profiling

The American Medical Association wants health insurers to standardize their doctor profiles and include clinical data from electronic health records; many carriers still balk.
So far, Ellwing said, two big national insurers--United and Cigna--have "signed on" to the guidelines. So have smaller plans such as Blue Cross Blue Shield of Tennessee, Intermountain, and Dakota Care. But many others have declined, in part because they feel the guidelines are too prescriptive.

Still, the AMA plans to continue discussions with the payers and hopes to convince more of them to go along. While Ellwing acknowledged that none are likely to follow the guidelines in toto, he said that they could use them to start moving toward standardized reporting that will be helpful to physicians. "The reason why insurers collect this data, analyze it, and put it in profiles is that they want physicians to do better. If they're really interested in improvement, they should want to provide this information in-depth enough and in a form that physicians can really use it. It's good for everyone."

While physician profiling has been around for decades, the AMA believes that its importance has grown in today's healthcare environment. "With the new payment methodologies that are coming, physicians who use their own data to improve their practice on quality and cost will be way ahead in the game," Ellwing stated.

It's not only large groups that can use this data to their advantage, he added. Even small physician practices can benefit if they understand how to use the data to improve their quality and efficiency.

The guideline document also makes clear that the AMA wants to influence how the health plans present the performance of individual physicians to consumers in web-based report cards. The AMA states, "Although consumer reporting is outside the scope of this document, the AMA recognizes that payers may provide physician performance data to their members and urges plans that provide these data to do so in a manner that facilitates consumer understanding of both the health plan information and the limitations of that data."

Healthcare organizations' top IT priorities in 2012 are focused on digitizing and managing patient information, achieving Meaningful Use, and meeting various government-related mandates and policy requirements. Download our Healthcare IT 2012 Priorities report. (Free registration required.)