Economic Credentialing and Physician Performance Measures: They Know Who You Are
David A. Wong, MD, MSc, FRCS(C); Laura L. Forese, MD, MPH

The impact of massive health reform looms large in the United States1. During the health-care debate, orthopaedic surgeons found politicians, health policy analysts, and health economists talking in a somewhat unfamiliar lexicon. Suddenly, data derived from the areas of economic credentialing and physician performance measures are being incorporated into major national health-care policy2 and are influencing policies and procedures down to the individual hospital level3. These determinations have the potential to radically change the practice of orthopaedic surgery for the foreseeable future. Such momentous times in medicine compel us to gain an understanding of the driving issues in health-care reform and the reliability and true utility of data derived from economic credentialing and physician performance measures. These concepts are key to the understanding of how health-care reform is positioned in the overall context of the present economic and political climate in the United States.

The Centers for Medicare and Medicaid Services (CMS), Office of the Actuary, reported that the percentage of gross domestic product spent by the United States on health care essentially doubled over the thirty years from 1975 to 2005 (from 8.1% to 16%)4. It is estimated that by 2015, that percentage will continue to increase to 19.2%4. Even before the present proposals for health-care reform became public, the Honorable David Walker, Comptroller of the United States and Director of the General Accounting Office, had written that, in terms of medical economics, the “current fiscal policy is unsustainable.”5 Walker estimated that, at the present rate of growth, the combined expenditure for the Medicare and Social Security programs would comprise 101% of predicted federal tax revenues by the year 2070. Substantial analysis and policy change would be required to sustain these programs. Walker summarized that “saving our future requires …

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