The Physician Profile System

Abstract The Physician Profile System is currently the most efficient and equitable mechanism of administering the payment to physicians under the usual and customary charge programs. Local peer review must be closely linked with the system to provide the assurance of reasonableness of charges, to resolve differences of opinion, and to scrutinize the utilization of health care resources. In actual practice, the Profile System permits for gradually increasing charges, both for the individual physician and for the medical community. It is equally capable of giving effect to lowered charges which sometimes follow technologic improvements. Usual and customary programs have not proved to be inflationary, and have developed conservative trend patterns which permit realistic prediction of future program costs. Experience has shown that physicians have not abused the usual and customary charge programs. Administrative and peer review devices provide an impressive array of checks and safeguards against abuses in the utilization of benefits and in the payment of physicians' charges.