In July 2008, Congress passed MIPPA, which directed the  Secretary of HHS to establish a program by January 1, 2009, to provide  physicians confidential feedback on the Medicare resources used to  provide care to beneficiaries. How to attribute resource use to physicians. Per Capita Profiling Method Shows Specialist Physicians’ Practice Patterns Relatively Stable Over 2 Years; Patients of High Resource Use Physicians Used More Institutional Services Than Other Patients

Using a per capita profiling method, we found that from 2005 to 2006,  specialist physicians showed considerable stability in their practice  patterns, as measured by resource use—greater stability than their  patients, despite high patient turnover. We also found that our per capita  method can differentiate specialists’ patterns of resource use with respect  to different types of services, such as institutional services, which were a  major factor in beneficiaries’ resource use. In particular, patients of high  resource use physicians used more institutional services than patients of  low resource use physicians. This stability suggests that per capita  resource use is a reasonable approach for profiling physicians, because it  reflects distinct patterns of a physician’s resource use, not the particular  population of beneficiaries seen by a physician in a given year. Research Literature, Health Insurers, and Specialists Identified Considerations in Developing Physician Feedback Reports on Resource Use

Through our review of selected literature and interviews with officials of  health insurance companies, specialty societies, and profiling experts, we  identified several key considerations in developing reports to provide  feedback to physicians on their performance, including their per capita  resource use. We also drew on information from these sources to develop  an example of how per capita measures could be presented in a physician  feedback report. Methodology. Data. Per Capita Measures Can Be Presented in a Physician Feedback Report

Drawing upon lessons culled from the literature and our interviews, we  developed a mock report that illustrates how per capita measures could be  included in a physician feedback report. 3.) Potential Influence of Feedback Regarding Medicare Costs on Physician Behavior Is Uncertain

Our review of available literature on the effectiveness of physician  feedback suggests that feedback alone generally has no more than a  moderate influence on physician behavior. CMS broadly agreed with each of our three findings:    CMS agreed that the per capita methodology is a useful approach to  measuring physicians’ resource use and noted that per capita  measurement is one of the cost of care measures included in CMS’s  Physician Resource Use Management and Reporting Program. CMS found the attention in our report to considerations for developing a  physician feedback system to be particularly helpful. Our results apply only to the four specialties in the four  metropolitan areas we studied.
Why GAO Did This Study

The Medicare Improvements for Patients and Providers Act of 2008 directed the Secretary of Health and Human Services to develop a program to give physicians confidential feedback on the Medicare resources used to provide care to Medicare beneficiaries. GAO was asked to evaluate the per capita methodology for profiling physicians--a method which measures a patient's resource use over a fixed period of time and attributes that resource use to physicians--in order to assist the Centers for Medicare & Medicaid Services (CMS) with the development of a physician feedback approach. In response, this report examines (1) the extent to which physicians in selected specialties show stable practice patterns and how beneficiary utilization of services varies by physician resource use level; (2) factors to consider in developing feedback reports on physicians' performance, including per capita resource use; and (3) the extent to which feedback reports may influence physician behavior. GAO focused on four medical specialties and four metropolitan areas chosen for their geographic diversity and range in average Medicare spending per beneficiary. To identify considerations for developing a physician feedback system, GAO reviewed the literature and interviewed officials from health plans and specialty societies. Further, GAO drew upon literature and interviews to develop an illustration of how per capita measures could be included in a physician feedback report.

What GAO Found

Using 2005 and 2006 Medicare claims data and a per capita methodology, GAO found that specialist physicians showed considerable stability in resource use despite high patient turnover. This stability suggests that per capita resource use is a reasonable approach for profiling specialist physicians because it reflects distinct patterns of a physician's resource use, not the particular population of beneficiaries seen by a physician in a given year. GAO also found that our per capita method can differentiate specialists' patterns of resource use with respect to different types of services, such as institutional services, which were a major factor in beneficiaries' resource use. In particular, patients of high resource use physicians used more institutional services than patients of low resource use physicians. GAO identified four key considerations in developing feedback reports on physician performance. To illustrate how per capita measures could be included in a physician feedback report, we developed a mock report containing three types of per capita measures. Although the literature suggested that feedback alone has no more than a moderate influence on physicians' behavior, the potential influence of feedback from CMS on Medicare costs may be greater, in part because of the relatively large share of physicians' practice revenues that Medicare typically represents. CMS reviewed a draft of this report and broadly agreed with our findings.