Ama Policy

Principles of Physician Profiling H-406.994


Our AMA advocates that managed care organizations, third party payers, government entities, and others that develop physician profiles adhere to the following principles:

(1) The active involvement of physician organizations and practicing physicians in all aspects of physician profiling shall be essential.

(2) The methods for collecting and analyzing data and developing physician profiles shall be disclosed to relevant physician organizations and physicians under review.

(3) Valid data collection and profiling methodologies, including establishment of a statistically significant sample size, shall be developed.

(4) The limitations of the data sources used to develop physician profiles shall be clearly identified and acknowledged.

(5) Physician profiles shall be based on valid, accurate, and objective data and used primarily for educational purposes.

(6) To the greatest extent possible, physician profiling initiatives shall use standards-based norms derived from widely accepted, physician-developed practice parameters.

(7) Physician profiles and any other information that have been compiled related to physician performance shall be shared with physicians under review.

(8) Comparisons among physician profiles shall adjust for patient case-mix, control for physician specialty, and distinguish between the ordering or referring physician and the physician providing the service or procedure.

(9) Effective safeguards to protect against the unauthorized use or disclosure of physician profiles shall be developed.

(10) The quality and accuracy of physician profiles, data sources, and methodologies shall be evaluated regularly.


Policy Timeline

CMS Rep. J, A-93 CMS Rep. 10, A-96 Reaffirmation A-01 Reaffirmation A-02 Reaffirmation A-05 Reaffirmed in lieu of Res. 724, A-05 Reaffirmed in lieu of Res. 729, A-09 Reaffirmation A-10 Reaffirmation I-10 Reaffirmed in lieu of Res. 824, I-10 Reaffirmation I-15