Physician Certification Pattern Review

Physician Certification Pattern Review, 2024 Annual Report 8 In the MMUR, all certifications using qualifying condition, (k) “Medical conditions of the same kind or class [SKC] as or comparable to those enumerated in paragraphs (a)–(j),” require identification of one or more qualifying conditions (a)–(j) the physician identifies as a match to the patient’s medical condition(s). Because a patient’s certification may include multiple medical conditions, and/or multiple matches to qualifying conditions (a)–(j), the records were sorted to review only those certifications with one other qualifying condition (a)–(j). In this reporting period, 69% (407,125 of 590,239) certifications met these conditions. See Table 6. Table 6: Number and percentage of times each qualifying condition (a)–(j) was identified as being the “same kind, or class” as the patient’s medical condition. Conditions listed in bold font are the top three reported by physicians. Qualifying Condition1 FY 2023 Number Percent2 (a) Cancer 3,566 0.88% (b) Epilepsy 6,157 1.5% (c) Glaucoma 426 0.1% (d) Positive status for human immunodeficiency virus (HIV) 1,444 0.4% (e) Acquired immune deficiency syndrome (AIDS) 165 0.04% (f) Post‐traumatic stress disorder (PTSD) 258,707 63.5% (g) Amyotrophic lateral sclerosis (ALS) 1,657 0.4% (h) Crohn’s disease 11,952 2.9% (i) Parkinson’s disease 2,270 0.6% (j) Multiple sclerosis (MS) 120,781 29.7% Total single qualifying condition reported: Number of distinct patients in this table: Number of physicians in this table: 407,125 299,767 728 1 Qualifying condition (k) patient medical condition(s) may align with more than one qualifying condition, only certifications with one (a)–(j) qualifying condition noted are shown here. 2 Percent of total number of single qualifying conditions reported. Table 7 provides an expansion of SKC data requested by the Panel in the 2021 recommendations to staff. The Panel was specifically interested in patient medical conditions physicians identified in certifications that identified qualifying condition (f) PTSD as being the same kind or class or as comparable to the patient medical condition.

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