Eventually every medical record will be accessible to payers, third-party review organizations, and government. Computer programs will monitor physician performance in hospitals and offices. Computer profiles of physician performance will compare one doctor with others on a hospital staff, or with peers across the nation. These profiles will be used for privileging, payment, and continuous economic credentialing. Large health systems will be able to centralize their assessment of physicians' performance, using cost and outcomes measures to compare primary-care doctors and specialists throughout the system, so as to standardize quality and cost.
Doctors have good reason to be nervous about economic credentialing.
Although few hospitals will have the nerve to drop a physician from the medical staff for any reason other than lapses in quality, HMOs, PPOs, insurance companies, self-insured employers, and even government will reward or punish doctors based on their cost of care. Doctors will economically credential other doctors. Independent practice associations will counsel physicians whose costs are out of line and drop them from managed-care panels if they are not compliant. Hospitals will be looking closely at factors like length of stay, use of ancillary tests from lab and radiology, consultations, number of office or clinic visits for the same patient, procedures, and cost per day. These will all be evaluated and compared from doctor to doctor.