VBC via CMS

By Staff Reporters

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PATTERNS OF MEDICAL RISKS

PATTERNS OF PRACTICE RISKS

One of the next big areas of risk that will surface in the near future is the Pattern of Practice Risk.

Pattern of Practice refers to the way that a particular physician practices medicine. With computers, eHRs, standardized diagnosis and treatment codes, and the budgetary restraints inherent in medical practice, it is becoming easy to analyze a physician’s method of practice.

The treatment and diagnosis codes that a physician uses and submits to third party payers can be quantified and compared colleagues in the same or similar specialties. Statistical outliers can be identified. These outliers will then be further audited and required to justify their treatments. If no rational basis exists for the statistical differences, the outlier may find himself the subject of a fraud investigation.

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