AMA: Fold IT Tools Into Physician Profiling - InformationWeek

InformationWeek is part of the Informa Tech Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them.Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

Healthcare // Electronic Health Records
12:30 PM

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.

We welcome your comments on this topic on our social media channels, or [contact us directly] with questions about the site.
1 of 2
Comment  | 
Print  | 
More Insights
InformationWeek Is Getting an Upgrade!

Find out more about our plans to improve the look, functionality, and performance of the InformationWeek site in the coming months.

New Storage Trends Promise to Help Enterprises Handle a Data Avalanche
John Edwards, Technology Journalist & Author,  4/1/2021
11 Things IT Professionals Wish They Knew Earlier in Their Careers
Lisa Morgan, Freelance Writer,  4/6/2021
How to Submit a Column to InformationWeek
InformationWeek Staff 4/9/2021
White Papers
Register for InformationWeek Newsletters
Current Issue
Successful Strategies for Digital Transformation
Download this report to learn about the latest technologies and best practices or ensuring a successful transition from outdated business transformation tactics.
Flash Poll