Physician performance measurement: tiered networks and dermatology (an opportunity and a challenge).

INTRODUCTION Over the past few years, the emergence of public profiling of physicians by health plans, pay-forperformance (P4P) contracts, and tiered provider networks have been heralded as endeavors to improve the delivery of medical care. Designed to align financial incentives and outcomes and rein in healthcare costs while demanding a purported higher quality of care, these efforts have been met with skepticism, confusion, and, at times, hostility from physicians. The medical profession, in principle, understands and supports efforts by insurance carriers to achieve more efficient and effective care. However, the execution of these programs has been concerning to the dermatology community in particular, given the challenges associated with identifying quality within this specialty in the ambulatory care setting and subsequently measuring it appropriately. As healthcare reform efforts infiltrate specialty markets, it is critical that all stakeholders understand and are prepared for the changes that will impact the way patient care is promoted, paid for, and measured. Herein we discuss ratings of physicians as they apply to the practice of dermatology and how they are used to create tiered networks. In addition, we share how tiered networks, if not implemented correctly, may undermine the improvements they seek. Finally, we suggest strategies for both payers and providers that will support transparency,