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Physician Profiling

Principles on Physician Profiling

The WSMA has adopted the following principles on physician profiling and the public release of physician-specific data:

  1. Physician organizations and practicing physicians who are representative of the profile group shall be meaningfully involved in the development of all aspects of the profile methodology, including collection methods, formatting, and methods, means and appropriate audience for release and dissemination.
  2. The entire methodology for collecting and analyzing the data shall be disclosed to all relevant physician organizations and to all physicians under review.
  3. Data collection and analytical methodologies shall be used that meet accepted standards of validity and reliability.
  4. The limitations of the data sources and analytic methodologies used to develop physician profiles, as well as appropriate and inappropriate uses of the data, shall be clearly identified and acknowledged.
  5. Physician profiling initiatives shall use standard-based norms derived from widely accepted, physician-developed practice guidelines to be used primarily to educate physicians.
  6. Physician profiles and any other information regarding physician performance shall be shared with those physicians under review prior to dissemination. Opportunity for corrections or the addition of helpful explanatory comments shall be provided prior to publication. The profiles shall either include only data that reflect care under the control of physician for whom the profile is prepared or shall state to what extent the data are not under the control of the physician.
  7. Comparisons of physician profiles shall adjust for patient case mix and other relevant risk factors, control for physician peer group when appropriate, and distinguish between the ordering or referring physician and the physician providing the service or procedure.
  8. Effective safeguards to protect against the unauthorized use or disclosure of physician profiles shall be developed and implemented.
  9. Effective safeguards to protect against the dissemination of inconsistent, incomplete, invalid, inaccurate, or subjective profile data shall be developed and implemented.
  10. The quality and accuracy of physician profiles, data sources, and methodologies shall be evaluated regularly.
  11. Physicians should be reimbursed for the reasonable costs that are required for assembling, formatting, and transmitting data and information to organizations that develop and/or disseminate physician profiles.
  12. The benefits of physician profiling should outweigh the costs of developing and disseminating the profiles. (CPA Rpt D, A-95)
  13. Physician-specific information released to the public must be relevant, meaningful, helpful, and reliable.
  14. Information released to the public should be conclusive; that is, information should not be released until a final determination is made.
  15. Information released to the public should be verifiable.

(CPA Rpt A, A-98) (Reaffirmed A-17)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services

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