Physicians subject to increasing scrutiny

Selected articles on trends, challenges and controversies in the changing world of medicine

Posted Jan. 30, 2012

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The federal government has been making moves to open up more physician decision-making to review by both officials and the public. Prepayment claims reviews, sunshine requirements and doctor report cards are some examples of recent policy changes designed to put more checks on physicians, whose decisions have a sizable impact on health spending and quality. American Medical News looked into some of the ways the government is taking a closer look.

Medicare intensifying documentation reviews before payment

Prepayment review is not a new concept to physicians, but Florida's Medicare contractor is taking the practice to new heights. Officials say the move will cut down on claims mistakes and other errors that lead to improper pay. Physicians worry that they'll be told after the fact that surgeries they performed were deemed medically unnecessary -- and that they owe Medicare any fees they've already received. Read more

CMS proposes sunshine rules on industry payments, gifts to doctors

Citing potential conflict-of-interest issues, the Centers for Medicare & Medicaid Services has drafted requirements that drug and device manufacturers disclose online any financial relationships they have with physicians that are of more than a nominal value. Physicians generally support such transparency measures, but they want to make sure an appeals process guarantees that doctors can correct reports that get it wrong. Read more

Medicare opens physician claims to researchers

Medicare doctor claims data, which generally are inaccessible to those who aren't program officials, soon will be available -- for a significant fee -- to outside entities that want to produce physician report cards for the public. Physicians oppose the limits placed on challenging the accuracy of the information, insisting that by the time data errors are sorted out, patients reading the report cards already will have been led astray. Read more

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