Public Reporting of Physician Performance, Guiding Principles

Preamble

The AAFP defines public reporting of physician performance as a way to compare physician practice patterns across various dimensions of cost and quality. While useful for comparative purposes, physician profiles are not a comprehensive assessment of physician quality and cannot be used to determine the quality of care provided to individual patients or as a measure of overall quality provided by individual physicians. Further, it is important to recognize that public reporting of physician performance 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.

The purpose of publicly reporting physician performance is to improve clinical outcomes and to enhance the ability of consumers to participate in and make decisions about healthcare. AAFP believes transparency in health care cost and quality information to physicians, patients, and employers is important and supports such efforts provided the data aggregation and analysis is consistent with the AAFP Performance Measures Criteria policy. These criteria encompass the framework in which physician performance data is collected, analyzed, and utilized.

While physician performance programs are developed to provide cost and quality data to physicians and patients, their value should be weighed against the subsequent administrative burden. 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).

Guidelines

Ideally, public reporting of physician performance should:

1. Support the physician/patient relationship.
2. Have as its purpose to assess the quality and efficiency of patient care and improve clinical outcomes.
3. Clearly define what is being measured, how performance scores are calculated, and how those scores are compared to peers.
4. Utilize criteria for comparison purposes that are based on valid peer groups, evidence-based statistical norms and/or evidence-based clinical policies.
5. Select measures that are actionable so physicians can easily act as needed to achieve improved quality of care.
6. Involve physicians in the selection of performance measures, and the development of a feedback process, and appeals process.
7. Explicitly describe the data sources on which measurement is based, e.g., administrative/claims, medical records, surveys, registry, etc.
8. Clearly report on the validity, accuracy, reliability and limitations of data utilized when reporting results and when providing physician feedback. Feedback provided may include:
   1. detailing the steps taken to ensure data accuracy and fair physician attribution of costs of care,
   2. clearly defining the peer group against which individual physician performance is being measured/compared,
   3. disclosing data limitations, e.g., measures in which the primary care physician may have little or no control over cost, patient choice, actions of other clinicians, or the completeness and representativeness of data,
   4. describing the attribution methodology and level of attribution of patient populations to either individual or physician groupings,
   5. assuring measurement is evidenced-based, reliable, and valid,
   6. appropriate risk adjustment in measurement, and
   7. establishing and reporting data using meaningful time periods for data collection.
9. Allow physicians to identify their individual patients who are not receiving indicated clinical interventions to support improvement relative to stated measurement.
10. Provide physicians performance profiles and allow review and reconciliation period prior to publication. This process includes providing:
    1. a minimum of 90 days for physicians to review, validate, and appeal their payer’s performance report before public reporting, and
    2. an immediate adjustment of physicians’ performance rating/designation(s) based upon a successful reconsideration or discovery of errors in the payer’s data
11. Provide consumers adequate guidance about how to interpret the physician performance information and explicitly describe any limitations in the data in lay terms.

(1999) (2019 COD)