The federal government will be sending warnings to hospital medical staffs if their physicians provide an abnormally high volume of inpatient services to Medicare beneficiaries.
The aim is to prod those medical staffs into becoming more efficient, as has happened when managed-care plans inform providers about how their utilization compares with that of their peers.
A little-noticed provision in the balanced-budget legislation signed into law earlier this month would require HCFA to project utilization of physician inpatient services for 1999 and 2001.
To estimate utilization in those years, HCFA would use as a baseline each medical staff's per-discharge utilization in 1997 and 1999.
The agency will average each hospital staff's number of per-discharge "relative-value units"-a numerical value used to establish doctors' fees that is based on the complexity of each physician service.
HCFA then will notify the medical executive committees of some of those hospitals identified as delivering an "excessive" volume of services, although the law does not state what volume would be considered excessive. The first notices will be sent to hospital medical staffs in 1999.
HCFA also will compare the future utilization of the high-volume hospitals that had been notified with those that had not, to determine whether receiving the notification had any impact on the behavior of their medical staffs.
The law, however, does not call for fee withholds on physicians on high-volume medical staffs, as President Clinton requested in his original balanced-budget plan. Those withholds would have been repaid if the staffs had later reduced utilization.
"Right now, we're sending them a serious warning" that they could face fee withholds if they do not reduce utilization, said a Senate aide.
But some provider groups fear that the profiling plan is a first step toward putting doctors at risk for high utilization.
Provider groups also question whether the data-reporting requirements might be too great for hospitals and HCFA alike. They also doubt that the often disorganized doctors on a hospital medical staff can collaborate the same way as physicians in group settings, where the practices have been financially integrated.
"It's hard to argue against knowledge," said Robert Dickler, senior vice president for the Association of American Medical Colleges. "(But) I do have a continuing concern."