Voluntary payer utilization of the general guidelines are designed to ensure a fair and accurate process through which physicians participating in a performance measurement program can request a reconsideration of performance ratings prior to public release.
The 11 principles included in the paper are listed below.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 120,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.
1. Prior to public release of performance ratings to the public or use of ratings to determine payment, physicians should be given the opportunity to review the ratings for accuracy, and at the physician's request, initiate reconsideration of their individual ratings. The payer should employ all possible means to ensure that no adverse determination regarding physician performance be made without prior review by the rated physician, and, when requested by the physician, ratings should be reconsidered by an appropriate and objective group of reviewers.
2. At the time of enrollment in a performance measurement program, and when ratings are first distributed for internal review, payers should provide physicians with a clear explanation of all program facets, including: the clinical guidelines and evidence that is graded upon which measures are based; the analytical methods used to aggregate, rate, and report data; the physician's right to an objective, timely, and expeditious reconsideration and appeals process; and a clear description of the reconsideration and appeals process, including the grounds for challenging ratings.
3. Payers should have a well-
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Contact: David Kinsman
dkinsman@acponline.org
202-261-4554
American College of Physicians
20-Apr-2007