Provider profiling: advancing to episodes of care.
Judging by the interest expressed by managed care organizations, provider profiling has arrived. Surveys indicate that most organizations have adopted, or plan to adopt in the near future, a means to describe provider practice patterns. A further vote of confidence came from providers: In 1994, the American College of Physicians, the largest national specialty organization, issued a position paper supporting provider profiling and questioning the value of other approaches to utilization management, such as preauthorization of individual services. Also, an article and an editorial in the New England Journal of Medicine cautiously supported the concept of profiling. Provider profiling has great promise as a means to promote cost-effective care without the limitations of case-by-case preauthorization. The combination of a sophisticated episode of care methodology and a set of validated practice benchmarks offers the opportunity to perform true clinical profiling and to supply providers with data to review and alter practice patterns.
Miller
L G
LG
Health Payment Review, Boston, MA, USA.
D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups; D017050:Episode of Care; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000145:classification*; D014481:United States; D014600:Utilization Review