The fairness and accuracy of reporting programs using physician-identified data have been points of contention between physicians and healthcare policymakers for more than decade and they remain so today as the American Medical Association and dozens of affiliated state and medical specialty societies weighed in Monday on a proposed federal public reporting rule under the Patient Protection and Affordable Care Act.
Doc groups concerned about reporting rule
“Just as the release of reliable information can be helpful for patients and physicians, the release of incorrect information could harm patients and the entire Medicare system,” Dr. Peter Carmel, the AMA president, said in a news statement about Monday's letter to CMS Administrator Dr. Donald Berwick. “The reports should compare apples to apples—using the same data from both private insurers and Medicare—and allow a full review and appeals process before publication, to provide the most accurate information.”
The 13-page letter (PDF) was submitted on behalf of the AMA and 81 other physician organizations.
“If done correctly,” the letter said, “public reporting has the potential to help provide appropriate and accurate information to patients, physicians and other stakeholders that can improve quality at the point of care. If not approached thoughtfully, however, public reporting can have unintentional adverse consequences for patients. For example, patient de-selection can occur for individuals at higher-risk for illness due to age, diagnosis, severity of illness, multiple co-morbidities, low literacy level, or economic and cultural characteristics that make them less adherent with established protocols. Programs must be designed so that appropriate and accurate information is available to patients to enable them to make educated decisions about their healthcare needs.”
Controversy over the efficacy of risk adjustments in publicly reported quality data and its impact on patient access to providers has been an issue since a handful of states, led by New York, Massachusetts, New Jersey, Pennsylvania and California began requiring the public reporting of outcomes by hospitals and by physicians for surgeries for coronary artery bypass graphs.
A 2005 article in the Archives of Internal Medicine, “The Influence of Public Reporting of Outcome Data on Medical Decision Making by Physicians,” on public reporting of physician-identifiable patient mortality rates in New York noted that nearly 80% of interventional cardiologists surveyed indicated the publication of mortality data influenced their decisions to perform angioplasties on high-risk patients.
Among those surveyed, 83%, according to the article, “agreed or strongly agreed that patients who might benefit from angioplasty may not receive the procedure as a result of public reporting of physician-specific patients' mortality rates. Also, 85% believed that the risk-adjustment model used in the Percutaneous Coronary Interventions (PCI) in New York State 1998-2000 report is not sufficient to avoid punishing physicians who perform higher-risk interventions.”
The AMA letter told Berwick it was important “that physicians have the opportunity to review their data that forms the basis for any public report. Physicians and other providers must have the opportunity for prior review and comment, along with the right to appeal, with regard to any data or its use that is part of the public review process. Any such comments should also be included with any publicly reported data. This is necessary to give an accurate and complete picture of what is otherwise only a snapshot, and possibly skewed or outdated view of the patient care provided by physicians and other professionals or providers. Further, the data used to profile physicians must be based on the quality of care provided, and never on utilization of resources alone.”
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