NIA Services - Physician Education: The Paramount Objective

Physician education on the appropriate utilization of diagnostic imaging is the paramount objective of NIA's Provider Data Sharing, Profiling, and Performance Feedback Program. Accordingly, NIA performs evidence-based provider performance reviews and profiling, along with tailored education of outliers, and reinforcement of "best practice" patterns.

Using healthplan guidelines, the NIA feedback/education process provides physician performance reviews in three key areas:

• Utilization Rates. We evaluate utilization rates by zip code, tracking the aggregate number of both ordering and rendering providers in that area. In high-utilization areas, providers can be evaluated using NIA's proprietary Appropriateness Filter.
  
  
• Appropriate Use of Technology. This aspect of the evaluation includes modality-specific reviews, the focus of which constantly adjusts to changes in provider utilization patterns. The process is frequent and varied to enhance the "sentinel effect" of the network development process. Instructional materials and NIA "town meetings" accompany all reporting to facilitate the open exchange of educational information.
  
  
• Billing and Coding Reviews. NIA performance evaluation also has the capability of identifying aberrant billing and coding practices, with an eye to pinpointing provider fraud. Broad educational efforts on this subject hold the potential for modifying provider practices.
  
  

Overall, the process is truly educational and measurable. It provides an opportunity for provider improvement and feedback. And it has been developed to conform to the principles of the 1999 Task Force Report of the American Academy of Family Physicians, entitled "Physician Profiling: Guiding Principles."