Medicare may start profiling physicians as soon as mid 2008. The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) develop a profiling system to identify physicians with inefficient practice patterns. At a House Ways and Means Subcommittee on Health hearing, Herbert Kuhn, acting deputy administrator of the CMS, said that identifying inefficient physicians, or “profiling,” would involve comparing the number of tests ordered by a physician for certain types of patients with the number ordered by colleagues in cases with the same outcome.
The GAO suggested that the program include financial or other incentives for physicians to improve the efficiency of the care they provide. The American Medical Association has expressed concerns that this program will be more about cost effectiveness than quality care for patients. Associations that testified at the Health hearing encouraged any profiling to be tied to education for self-improvement rather than reimbursement.
Now it is even more important for rheumatologists to have accurate patient medical records. In an effort to avoid audits and penalties, some rheumatologists may downcode patient visits. Downcoding not only hurts your practice, it may adversely affect other rheumatologists in your area.
To read the GAO report, go to www.gao.gov and search for gao-07-307. If you have questions, contact Melesia Tillman, CPC, at [email protected] or (404) 633-3777 ext. 820.
