Physician Performance: Report Cards Under Development but Challenges Remain Page: 5 of 38
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the medical group, may not be very helpful for making an informed choice
of a physician. In addition, questions about the accuracy and completeness
of the data and the adequacy of the risk adjustment methodology limit
consumer and physician confidence in the report cards.
Some organizations are collaborating to develop more comprehensive,
standardized performance measures and to facilitate the exchange of
clinical and administrative data between physicians, plans, and
purchasers. For example, several national accreditation organizations
have formed a council to develop common performance measures. At the
federal level, the Department of Health and Human Services (HHS) is
working on a performance measurement system for its Medicare
fee-for-service program and has been supporting research and working
with other organizations to develop physician performance measures. In
addition, HHS is establishing standards for administrative claims and
encounter data as well as unique identifiers for individuals, plans, and
providers-efforts that should help iHS and others in their performance
To date, most performance information has provided only data on health
plans as a whole. Changes in the health care market-particularly the
growth in the size of plans, the shifting of greater financial risk to
physicians or physician groups, and the requirement in some cases that
beneficiaries receive all their care from selected physicians within a
plan-have made plan comparisons less useful for many consumers. Many
consumers do not get to choose their health plan and even for consumers
who can choose among plans, an individual physician's performance may
deviate greatly from the health plan's average. These and other factors
have prompted calls for physician report cards that can help consumers
select physicians from those available within their health plan.
Report cards are generally publicly released reports on the quality of care
that provide comparative information on plan characteristics and
performance. One widespread report card for health plans is prepared by
the National Committee on Quality Assurance (NCQA). NCQA uses its Health
Plan Employer Data and Information Set (HEDIS) to report on plan
performance. HEDIS includes more than 60 performance indicators
covering quality, access to and satisfaction with care, membership and use
of services, finance, and management.
GAO/HEHS-99-178 Physician Report Cards
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United States. General Accounting Office. Physician Performance: Report Cards Under Development but Challenges Remain, report, September 30, 1999; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc293055/m1/5/: accessed April 25, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.