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Physician Performance Reporting, Guiding Principles
- Support the physician/patient relationship.
- Provide physician performance reports/ratings to assessed physician within meaningful time periods and be compared against both peers and performance targets prior to being made public.
- Be transparent in all facets of physician measurement analysis, including:
- origin and definitions of data sources
- number of cases assessed per measure
- performance measures utilized and their source
- margin of error assumed in calculations
- basis of evaluation - the individual physician or physician group level
- clear communication of the validity, accuracy, reliability and limitations of data utilized, which may include:
- defining the peer group against which individual physician performance is being measured/compared;
- detailing steps taken to ensure data accuracy and disclose data limitations, e.g., the impact of an "open access" product in which the primary care physician may have little or no control over resource utilization;
- describing the assignment of patient populations to either individual or physician groupings;
- including appropriate risk adjustment and case mix measures; and
- using meaningful time periods for data comparisons.
- Identify physicians that meet quality standards separately from their cost assessment
- Utilize appropriate and easy to understand designations for physicians who:
- have statistically insufficient data to assess physician performance;
- have data currently under review with pending results;
- have declined to display their designation;
- have insufficient claims data with the payer for evaluation;
- practice in a specialty that is not evaluated under the program;
- practice in a market where the payer’s program is not available; or
- have not met payers’ criteria for a designation.
- Provide a minimum of 90 days for physicians to review, validate, and appeal their payer’s performance report before public reporting.
- Immediately adjust physicians’ performance rating/designation(s) based upon a successful reconsideration or discovery of errors in the payer’s data analysis.
- Provide consumers adequate guidance about how to use the physician performance information and explicitly describe any limitations in the data.