AMA: Fold IT Tools Into Physician Profiling - InformationWeek
Healthcare // Electronic Health Records
12:30 PM
Building Security for the IoT
Nov 09, 2017
In this webcast, experts discuss the most effective approaches to securing Internet-enabled system ...Read More>>

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.

10 Top Medical Practice Management Software Systems
10 Top Medical Practice Management Software Systems
(click image for larger view and for slideshow)
The American Medical Association (AMA) has released guidelines aimed at encouraging health insurers to standardize their physician profiling reports. These reports, which the plans send to physicians, are often used as the basis for pay-for-performance programs, tiered networks, and narrow networks, and they may also be used in public reporting of physician quality and cost indicators.

While the performance reports are mostly based on claims data, the AMA looks forward to the day when physician profiles will also include clinical data from electronic health records, said Steve Ellwing, director of physician practice advocacy for the AMA, in an interview with InformationWeek Healthcare.

The AMA also wants health plans to make the profiles available to physicians on web portals, rather than sending them long printouts. This would make it easier for physicians to peruse the data and to drill down to specific patient information, Ellwing said.

The overall purpose of the guidelines, he explained, is to get health plans to give physicians the data they need to improve the quality of care. "Some insurers will provide very minimal information--aggregate scores or whatever. Others will go down all the way to the individual patient level. If the insurers can give data at the patient level to physicians, the doctors can use that data to identify areas for practice improvement."

[ Most of the largest healthcare data security and privacy breaches have involved lost or stolen mobile computing devices. For possible solutions, see 7 Tools To Tighten Healthcare Data Security. ]

The other requirement, Ellwing added, is that the information be easy to understand and use. Not only are many health plan reports complex and difficult to grasp, but each insurer reports the data differently.

Initially, the AMA proposed a standardized form that all insurers could use. But the plans rejected that concept, Ellwing recalled. "The message we got is, 'We've spent tens of millions of dollars developing our reporting format, so there's no way we're going to take a standardized form that you've developed.'"

The current guidelines for physician profiling reports were developed in conjunction with insurers, employers, consumer groups, and regulatory bodies, including the Centers for Medicare and Medicaid Services (CMS). In creating the guidelines, Ellwing noted, AMA tried to avoid calling for the plans to change any of their policies. However, the document does ask the insurers to let physicians report errors in reports, such as information on patients they've never seen, and to appeal quality or cost profiles that they believe misrepresent their performance.

1 of 2
Comment  | 
Print  | 
More Insights
Newest First  |  Oldest First  |  Threaded View
How Enterprises Are Attacking the IT Security Enterprise
How Enterprises Are Attacking the IT Security Enterprise
To learn more about what organizations are doing to tackle attacks and threats we surveyed a group of 300 IT and infosec professionals to find out what their biggest IT security challenges are and what they're doing to defend against today's threats. Download the report to see what they're saying.
Register for InformationWeek Newsletters
White Papers
Current Issue
2017 State of IT Report
In today's technology-driven world, "innovation" has become a basic expectation. IT leaders are tasked with making technical magic, improving customer experience, and boosting the bottom line -- yet often without any increase to the IT budget. How are organizations striking the balance between new initiatives and cost control? Download our report to learn about the biggest challenges and how savvy IT executives are overcoming them.
Twitter Feed
Sponsored Live Streaming Video
Everything You've Been Told About Mobility Is Wrong
Attend this video symposium with Sean Wisdom, Global Director of Mobility Solutions, and learn about how you can harness powerful new products to mobilize your business potential.
Flash Poll