American College of Physicians: Internal Medicine — Doctors for Adults ®

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Doctor profiling can be your practice's key to success

From the February 1996 ACP Observer, copyright 1996 by the American College of Physicians.

Editor's note: This article is part of ACP Observer's occasional column dealing with questions about managed care. This month's respondent is Franklin Brosgol, ACP Member, founder of Hunt Medical Management Consulting in Fort Lee, N.J. The company, a branch of P3 Inc., specializes in software and services that prepare physicians to deal with managed care organizations. Previously, Dr. Brosgol was in general internal medicine for 25 years.

Q. What does my internal medicine practice have to gain from physician profiling?

A. In today's managed care environment, profiling--gathering and reporting physicians' performance data and comparing results with those of their peers--is not only profitable for internists, but essential to the success of a private practice.

The gains can be economic: Physicians who document their primary care services and office hours may negotiate higher reimbursements from managed care organizations. For example, one well-known managed care organization pays a higher capitation rate to primary care physicians who demonstrate above- standard rates of mammographies, Pap smears and immunizations in general and eye exams for diabetic patients. Physicians who have evening and weekend office hours may get a higher capitation rate because they prevent patients from making unnecessary trips to the emergency room.

The gains can also be professional: Physicians can use the results of profiling to monitor treatment outcomes, patient compliance and referral results to improve their practice patterns. For example, a physician may decide to establish a patient recall system that results in a high percentage of women coming in for annual preventive exams.

What are some of the best ways to collect data? Some computer programs help physicians profile their practices and compare their practice patterns to the expectations and reimbursement policies of managed care organizations. One cost-effective way of gathering data--a good option for solo or small group practices--is through patient satisfaction surveys. These surveys can determine how patients perceive a practice's quality of care and service.

Once physicians can capture, store and evaluate data, they can analyze any extra costs such as adding extra personnel that often accompany joining a managed care organization.

Physicians should strive to establish markers of performance that can be readily measured. Results from profiling these markers can help identify individuals, facilities or areas that may need further review.

While some physicians are wary of having their work objectively and professionally evaluated, I think it's a good idea. It improves practice patterns and office efficiency, and it provides valuable documentation that can increase revenue. Most importantly, profiling puts physicians in control of improving patient outcomes and satisfaction.

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