I am a medical director and on salary, so I have no skin in this profiling game. I practiced family medicine for 23 years prior to accepting an administrative position, so I have long experience in dealing with all levels of patient care. Here is a very big caveat.
Unless patients are risk-stratified by disease state, multiple disease states and ethnic/social levels, it is very dangerous to say a physician admits patients to hospitals or nursing homes more, or, in fact, is more expensive. Claims costs only tell part of the story. Some inner-city physicians, and those who care for elderly, debilitated patients with multiple medical conditions and little financial resources, will always have poor cost profiles.
If the CMS drew some arbitrary conclusions from non-risk-adjusted data, these docs could be excluded from providing services or labeled as bad or inefficient physicians. Costs would not come down, as all these patients would then have no physicians, or would be forced to see other preferred doctors. All their diseases, their social situations and their noncompliant behaviors would still be present, so what would be changed?
Bernard J. Emkes, M.D.Indianapolis
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