Medicare: Providing Systematic Feedback to Physicians on their Practice Patterns Is a Promising Step Toward Encouraging Program Efficiency: GAO-07-862T

Steinwald, A. Bruce
May 2007
GAO Reports;5/10/2007, p1
Government Document
GAO was asked to discuss--based on Medicare: Focus on Physician Practice Patterns Can Lead to Greater Program Efficiency, GAO-07-307 (Apr. 30, 2007)--the importance in Medicare of providing feedback to physicians on how their use of health care resources compares with that of their peers. GAO's report discusses an approach to analyzing physicians' practice patterns in Medicare and ways the Centers for Medicare & Medicaid Services (CMS) could use the results. In a related matter, Medicare's sustainable growth rate system of spending targets used to moderate physician spending growth and annually update physician fees has been problematic, acting as a blunt instrument and lacking in incentives for physicians individually to be attentive to the efficient use of resources in their practices. GAO's statement focuses on (1) the results of its analysis estimating the prevalence of inefficient physicians in Medicare and (2) the potential for CMS to profile physicians in traditional fee-for-service Medicare for efficiency and use the results in ways that are similar to other purchasers' efforts to encourage efficiency. Having considered efforts of 10 private and public health care purchasers that routinely evaluate physicians for efficiency and other factors, GAO conducted its own analysis of physician practices in Medicare. GAO focused the analysis on generalists--physicians who described their specialty as general practice, internal medicine, or family practice--and selected metropolitan areas that were diverse geographically and in terms of Medicare spending per beneficiary. Although GAO did not include specialists in its analysis, its method does not preclude profiling specialists, as long as enough data are available to make meaningful comparisons across physicians. Based on 2003 Medicare claims data, GAO's analysis found outlier generalist physicians--physicians who treat a disproportionate share of overly expensive patients--in all 12 metropolitan areas studied. Outlier generalists and other generalists saw similar numbers of Medicare patients and their respective patients averaged the same number of office visits. However, after taking health status and location into account, GAO found that Medicare patients who saw an outlier generalist--compared with those who saw other generalists--were more likely to have been hospitalized, more likely to have been hospitalized multiple times, and more likely to have used home health services. By contrast, they were less likely to have been admitted to a skilled nursing facility. GAO concluded that outlier generalists were likely to practice medicine inefficiently. CMS has tools available to evaluate physicians' practices for efficiency, including a comprehensive repository of Medicare claims data to compute reliable efficiency measures and substantial experience adjusting for differences in patients' health status. The agency also has wide experience in conducting educational outreach to...


Related Articles

  • The New Medicare. Rosa, TaĆ­na // Caribbean Business;2/9/2006, Vol. 34 Issue 5, p20 

    The author examines the benefits of the Medicare Advantage (MA) plans to the health insurance industry in Puerto Rico. The MA was developed in 2003 to replace the Medicare Plus Choice. The expanded coverage of MA includes optical and dental. It also allows private health insurance companies to...

  • The Health Care Philosophy that Nearly Destroyed Medicare in Canada in a Single Decade. Beck, Ivan T.; Thomson, Matthew // Clinical & Investigative Medicine;Apr2006, Vol. 29 Issue 2, p65 

    In 1989, governments in Canada perceived an economic crisis in health care funding and commissioned two economists, Drs. Barer and Stoddart, to review policies. They indicated the major costs were caused by physicians and recommended cutting physician training and hospital facilities. In 1991,...

  • Advocates say health care gap exists in aid net. HOLZMAN, PAULA // Central Penn Business Journal;6/19/2009, Vol. 25 Issue 25, p3 

    The article focuses on the gap that exists within the health care sector in Lebanon County, Pennsylvania. It is stated that free health care clinics have been set up for residents who are not insured. According to the author, such an effort will be less effective for residents who receive...

  • Privacy Act Basics for Private Practitioners. Hasselkus, Amy; Romanow, Kate // ASHA Leader;9/1/2009, Vol. 14 Issue 11, p3 

    Several questions and answers related to medical care are presented, including one who relates whether everyone needs to comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, another who inquires whether he will automatically become a covered entity if he apply a...

  • Medicare Home Health Benefit: Impact of Interim Payment System and Agency Closures on Access to Services: HEHS-98-238.  // GAO Reports;9/9/1998, p1 

    Until 1996, Medicare spending for home health care had been rising dramatically, consuming about $1 in every $11 of Medicare outlays in 1996, compared with $1 in every $40 in 1989. To control this rapid cost growth, the Health Care Financing Administration was required to implement a prospective...

  • MEDI-CHOICE. Elhauge, Einer // New Republic;11/13/95, Vol. 213 Issue 20, p24 

    Defends the use of vouchers in exchange for Medicare benefits proposed by Republicans in a reform bill in the U.S. Congress. Contribution of Medicare funding waste to problems in the national budget; Other competing reform bills proposed in Congress; Source of Medicare funding deficit; Effect...

  • Congress Contemplates Options On Medicare "75% Rule"  // PT: Magazine of Physical Therapy;Jul2004, Vol. 12 Issue 7, p66 

    Looks into the release of the final regulations regarding the criteria that Medicare will use to define inpatient rehabilitation facilities (IRF) in the U.S. Failure of the U.S. Centers for Medicare & Medicaid Services to accept recommendations for revising its current policy on IRF; Expansion...

  • RULES & REGS.  // Materials Management in Health Care;May2004, Vol. 13 Issue 5, p10 

    Reports on news and developments concerning the medical care sector. CMS implementation of provisions of the Medicare Modernization Act; Changes in the way CMS accepts Medicare claims under the Health Insurance Portability and Accountability Act; Authorize hospital funding for fiscal 2005 to...

  • 'Significant' Increases In Medicare Advantage Health Plan Rates Aimed At Supporting Better Service.  // Insurance Advocate;1/26/2004, Vol. 115 Issue 4, p30 

    Focuses on the increases in federal payment rates for Medicare Advantage health plans aimed at supporting improvements in services and lower costs for Medicare beneficiaries enrolled in private health plans in the U.S. Total amount of the increase; Benefits of the increase to seniors.


Read the Article

Other Topics