The AAFP defines physician profiling as an analytic tool that uses epidemiological methods to compare physician practice patterns across various quality of care dimensions (process and clinical outcomes). Cost, service and resource utilization data are dimensions of measuring quality, but should not be used as independent measures of quality care. The ultimate goal is to deliver high quality, evidence-based care to improve clinical outcomes.
It is important to recognize that physician profiling is not intended to 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 that exist for these purposes.
AAFP believes that transparency in health care cost and quality information to physicians, patients, and employers is important and supports such efforts provided that the data aggregation and analysis is consistent with the AAFP Performance Measures Criteria policy. These criteria encompass the framework in which physician profiling data is collected, analyzed, and utilized.
Family physicians must have an opportunity to review payer performance profiles prior to them being publicly reported. Payers must establish and communicate a reasonable, formalized reconsideration process in which physicians can appeal their performance rating/designation(s).
Ideally, any physician profiling system/program should:
(1999) (2012 COD)
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Physician Profiling, Guiding Principles