PHYSICIAN PRACTICE: Risk Managers to Physicians: 3 Strategies Keep Your Practice in the Safety Zone

Why This Topic Matters

Practice patterns can attract attention from auditors, payers, and government agencies when they appear outside expected norms. Understanding how to evaluate and explain those patterns helps practices reduce compliance, reputational, and malpractice risk.

Article Sections

1. Introduction

   Introduces the concern over utilization patterns and the need for physicians to assess how their practice compares with broader standards. It frames the topic around compliance, peer comparison, and risk management.

2. 3 Ways to Stay Problem Free

   Outlines three general strategies for reviewing practice behavior and responding to scrutiny. The section centers on benchmarking, identifying outliers, and considering payer-related differences.

3. Use specialty practice guidelines as a benchmark

   Discusses the role of specialty clinical practice guidelines as a reference point for assessing care patterns. It emphasizes comparing current practice with recognized professional standards.

4. Examine and explain outlier practices

   Addresses how to evaluate physicians whose patterns differ from peers and the kinds of broad factors that may account for variation. It also touches on how differing clinical viewpoints can affect practice patterns.

5. Compare care for different populations with the same conditions

   Reviews the importance of looking at differences in care across patient groups and payers. It highlights the relevance of preauthorization and reimbursement-related variation as risk areas.