Claims data an appropriate basis in pay-for-performance programs

LETTER — Posted Dec. 11, 2006

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Regarding "Blues plans are creating a giant claims database" (Article, Sept. 11): In this article the use of insurance companies to evaluate physicians' performance is decried, but this practice is not a bad thing at all.

The most efficient approach to implementing pay-for-performance is to use claims data. This way, the process of collecting and reporting on physicians' performance would be automated. Additionally, the responsibility for pay-for-performance reporting would rest on the shoulders of the insurance companies, rather than on the shoulders of already-overburdened physicians. G-codes [for pay-for-performance reporting] are a bad idea, and totally unnecessary if claims data is used instead.

The concern about insurance companies identifying physicians who are more cost conscious seems unfounded. If the insurance company states Dr. Cheap is more cost conscious than Dr. Expensive, the savvy patient will run as fast as he can to Dr. Expensive, since Dr. Expensive will be more likely to order the clinically indicated specialty consults, MRIs and blood tests.

If the insurance company states that Dr. Cheap is a better doctor than Dr. Expensive, then Dr. Expensive has a lucrative lawsuit to press.

Matthew Beckwith, MD, Hagerstown, Md.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/12/11/edlt1211.htm.

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