This project identified fee-for-service payer and managed care plan arrangements with efficient, high quality physicians and physician-group practices; best practice profiling methodologies; criteria used in selective contracting, including financial profiling; barriers to selective contracting; and bonus arrangements for high quality physicians.
Researchers estimated Medicare (Part B) physician expenditures and simulated possible program savings or losses from alternative selective contracting policies based on best industry practices. The use of physician quality and economic profiling by payers and employers in evaluating physicians for staff appointment, reappointment or selective contracting has been suggested as an industry practice that would modernize Medicare payment practices. The use of bonus payments to efficient and high quality physicians to keep Medicare program costs down and quality of service up has been cited as another industry practice appropriate for modernization of Medicare. Quantitative analyses were performed pertaining to physician profiling for echocardiograms, magnetic resonance imaging, and computed tomography (CT) scans.
The hope was that these descriptive and qualitative analyses would lead to recommendations for best practice profiling criteria to identify efficient and qualified physicians and group-practices. It was determined, however, that more detailed case-mix adjustment and accepted clinical guidelines for ordering tests would be needed to identify over- or under- referral of imaging tests.
Report Title: Environmental Scan for Selective Contracting Practices with Efficient (Qualified) Physicians and Physician Group Practices. Report may be obtained from Federal Contact
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Jesse Levy, 410-786-6600
Performer: RTI International
PIC ID: 8601