Physician Performance Monitoring Policy

Reminder: Physician Performance Monitoring Policy

Independent Health has had a Physician Evaluation Program, and details about this program are below.

To provide more transparency surrounding this program, Independent Health recently established and communicated to physicians about the Physician Performance Monitoring Policy, which went into effect on December 1, 2015.
View the policy on our website (log in is required).

Details about the Physician Evaluation Program
The IPA/WNY Board has reviewed and approved this process which measures physicians against like peers/practices that use similar treatment modalities and serve a comparable patient population. It was developed to establish consistent criteria and thresholds to evaluate participating physician performance and institute action plans that are efficient and effective at resolving instances of substandard services or patient care that has been determined to be outside the professional standard practice. The physician evaluation process is objective and evaluates the following key performance measures:

  • Efficiency Index
  • Effectiveness Index
  • Controlled Substance Utilization Index
  • Generic Medication Utilization Index
  • Member Complaints
  • Malpractice claims history
  • NYS Office of Professional Misconduct (OPMC ) Licensing Restrictions and Sanctions
  • Quality of Care Concerns
  • SIU review and evidence of abuse or fraudulent billing
  • Non-compliance to include, but not be limited to, non-compliance with contract or policy, quality improvement activities, medical management, and recredentialing activities

If you have additional questions regarding this policy, please contact Deborah Robinson at (716) 635-4938 in the Clinical Quality Department, Monday – Friday between 8:00 a.m. to 4:00 p.m.