Physician Ratings

CO laws let physicians contest health plan rating systems, establish system reforms

Anne Zieger — Tue, 01 Jul 2008 10:33:23 -0400

The state of Colorado has enacted new rules which will allow doctors to review and challenge health plan rating systems, a move that comes as part of a larger package of state healthcare reforms. The bill, signed earlier this month by Gov. Bill Ritter (D), also includes provisions allowing patients to have standardized health plan IDs and giving insurance companies the ability to develop new types of plans that the state may help consumers purchase. In addition to giving doctors the ability to review and question health insurance ratings of their performance, the new bills require health plans to disclose their systems for profiling or rating doctors. These rules arose partly out of discussions held between insurers and physicians in 2006 when UnitedHealth Group and PacifiCare Health merged. However, they were also influenced by health plan rating reforms pushed through by New York Attorney General Andrew Cuomo.

The new health plans authorized by the state are intended to expand access to care for the state's approximately 800,000 insureds. They allow for the development of "Centennial Care Choices," a program under which private health plans could provide basic coverage to the uninsured at a target premium of about $200 per month for individuals. This, of course, resembles plans already in existence in Massachusetts, where reforms have been in place for about one year.

To learn more about health system changes in Colorado:
- read this AMNews article

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Survey: Few patients rely on physician ratings

Abby Christopher — Mon, 23 Jun 2008 14:43:20 -0400

Although legions of doctors have bristled at the physician rankings that are widely available online, most consumers in fact do not use the rankings when choosing a provider, medical facility or even an insurance carrier, for that matter. According to the results of a Harris Poll recently commissioned by the California Healthcare Foundation, most patients favor word-of-mouth recommendations to scorecards published on the Internet, which the American Medical Association opposes in some cases. Only 1 percent of surveyed respondents made a change in their hospital or health plan based on ratings sites. The survey found that consumers mainly use the Internet to learn more about specific diagnoses or symptoms. However, some clinicians don't believe that the survey results mean that providers and carriers should trivialize evaluations posted on the Internet, recognizing that consumers may embrace online ratings in the near future.

For more info:
- read the full story at American Medical News

Study: Patients don't typically use online ratings

Anne Zieger — Mon, 16 Jun 2008 01:02:08 -0400

Though physicians fear that their business will be adversely affected by off-the-cuff online ratings, few patients actually make use of such ratings, according to new research. A Harris Interactive poll commissioned by the California HealthCare Foundation concluded that while more than 80 percent of the state's adults use the web for health information, less than one-quarter have made use of physician ratings sites. More significantly, only 2 percent of those surveyed had changed doctors based on ratings-site information. Even fewer (1 percent) changed hospitals or health plans based on data from ratings sites. All that being said, more people are looking at physician ratings sites than they were three years ago. Harris found that the number of people who looked at physician ratings sites climbed from 14 percent in 2004 to 22 percent in 2007.

Even though consumers aren't heavily influenced by web ratings today, medical groups are well aware that things can change. For that reason, the AMA continues to monitor the practice of physicians ratings online, and has occasionally taken action to oppose such schemes.

To learn more about the study:
- read this AMNews article

Using claims data for doctor ratings poses big problems

Fri, 23 May 2008 06:59:59 -0400

In theory, physician ratings and rankings aren't as scary as they used to be a few years ago.

With activists like New York Attorney General Andrew Cuomo helping to spark systematic changes in such programs, health plans aren't shooting from the hip as much as they were before. Not only do health plans have to "behave" in New York, they're taking the new standards with them to their entire commercial populations (such as Cigna, which brought in the NCQA to oversee its entire ranking system).

Not only that, it's looking like some big stakeholders are starting to agree on what they want to measure. According to a recent announcement from the oh-so-respectable Robert Wood Johnson Foundation, a group of leading stakeholders in provider rating including the Leapfrog Group, the National Business Coalition on Health, the AFL-CIO, the American Medical Association and America's Health Insurance Plans have all agreed on a "Patient Charter" that sets principles for measuring doctors' performance. That ought to help, right?

Still, not everybody's happy, despite the progress that's been made to date. For example, just consider the Massachusetts Medical Society, which is suing over rankings it says are capricious and actively defraud consumers. It's main beef is that the claims data health plans are using to rank its members just don't cut it.

And there, folks, is one of the most stubborn obstacles to straightening this mess out. Let's say that the industry's leaders all agree on what's fair and reasonable to measure clinically, and that they reach some grudging consensus that cost is an issue worth using as some form of ratings scale. Given the extraordinarily complex, flawed and cryptic puzzle that is claims data, it seems unlikely that anyone can use it to make fair deductions about physician performance on a granular level.

OK, I realize that some of you will blanch when you read that, but I have to tell you that the preponderance of what I've read and seen suggests that this is true--if for no other reason than that in attempting to do a good job and pay fairly, the system is breaking under its own weight. (If you think I'm way off base, please feel free to write and tell me so. Some of these folks might be first in line.)

Look, it seems pretty clear that some form of ranking will arrive at some point. But in the meantime, it just isn't going to work to force quality numbers onto a data set that arrives at the door broken. Maybe, when we have a fully-implemented electronic medical records universe out there, we can rethink the whole thing. For now, perhaps health plans can come up with some other way of motivating doctors to play ball? - Anne

CIGNA launches site offering doctor, hospital rankings

Fri, 23 May 2008 06:59:57 -0400

CIGNA has launched a national website ranking doctors and hospitals by cost and quality measures, along with providing its beneficiaries with several additional tools to help them obtain care. Not only does the site rank providers, it also names hospitals in specific regions with the lowest death and complication rates. In addition, it offers lists of questions patients can ask their doctor in regards to specific conditions, and offers patients tools to help them locate nearby pharmacies with the lowest prices.

At least where New York physicians are concerned, Cigna's program will be under the scrutiny of a fierce watchdog. New York Attorney General Andrew Cuomo has investigated several of the state's health plans as they rolled out rating and ranking programs, and Cigna was one of the plans asked to sign an agreement detailing the practices it would adhere to in establishing ranking programs. Cigna has since hired the National Committee for Quality Assurance to oversee its ratings program for the entire U.S.

To learn more about CIGNA's rankings program:
- read this Atlanta Journal-Constitution article

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MA physician group files suit over rankings

Thu, 22 May 2008 06:59:58 -0400

The Massachusetts Medical Society has filed suit to stop a scheme under which doctors are ranked using cost and quality metrics by health plans working with an agency overseeing health insurance plans for public employees. The MMS says that the Group Insurance Commission (GIC), which works with thousands of state and local employees, defamed doctors that it arbitrarily ranked lower, and defrauded patients who pay higher co-payments based on their doctor's ranking.

The medical society had worked with the GIC for four years to improve its methods, and concedes that the agency made some changes. However, it still ranks individual physicians "using inaccurate, unreliable, and invalid tools and data," according to Dr. Bruce Auerbach, MMS's president.

To compile its individual physician rankings, the GIC runs an analysis on a claims database drawn from six insurance companies. However, the MMS says this approach has many flaws, including that it penalizes doctors that take on complex, expensive cases. Also, the data itself may reflect, for example, full expenses for cases in which a doctor read a chart but didn't participate in care, skewing the individual's cost results dramatically.

To learn more about the dispute:
- read this article from The Boston Globe

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CO bill would set standards for physician rating, tiering

Fri, 02 May 2008 06:59:55 -0400

Colorado's governor is considering a bill that would require the state's health plans to disclose the data and methods they use to create physician tiers. In so doing, the state would follow the lead of New York, which has taken aggressive steps to regulate physician rating programs, including proposed legislation and a model standard set by the state attorney general.

With tiering programs, health plans rank physicians based on their preferred quality ratings, then offer members discounts for those who only see the highest-rated tier of physicians. In addition to demanding transparency on what they're doing, the Colorado bill would set standards for how data is used, requiring, for example, that plans utilize risk-adjusted data, base grades and ratings at least partly on nationally-recognized quality standards.

To learn more about the bill:
- read this AMNews article

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Groups come together on MD performance reporting

Wed, 02 Apr 2008 07:59:58 -0400

Measuring performance is one of the toughest nuts the healthcare industry has to crack. But this time, some important stakeholders have at least come together to handle the problem as a team. Groups backing the new Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs include the American Medical Association, American Academy of Family Physicians, the AARP, American College of Physicians, America's Health Insurance Plans, the Leapfrog Group, AFL-CIO, National Business Coalition on Health and health insurers Aetna, Cigna, UnitedHealth Group and WellPoint.

The Charter creates a set of shared principles that will structure measuring and reporting on doctor performance. It urges health plans to develop consistent performance measurements on cost and quality, adopt National Quality Forum standards; use transparent methods for creating programs and give physicians a chance to participate and, if they desire, appeal their scores.

To learn more about the project:
- read this Modern Healthcare piece (reg. req.)
- visit the group's website

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Errors force BCBS of TN to postpone doctor ratings

Tue, 11 Mar 2008 07:59:55 -0400

Dogged by complaints that its data was inaccurate, BlueCross BlueShield of Tennessee has put its planned doctor rating program on hold. During a 60-day review period BCBS gave doctors, the physicians came back with many complaints about inaccuracies. For example, the data sometimes suggested that they didn't perform certain tests, even though the doctors had such tests documented in their own records. In such cases, the health plan has been allowing doctors to submit their records to supplement the claims data it uses for ratings. After it responds to doctors' questions and concerns, BCBS of Tennessee still expects to publish physician quality and cost data, which will be available to privately-insured members through a secure web connection.

Unlike its health plan brethren in New York, BCBS of Tennessee doesn't have to live up to any regulatory or legislative standards in compiling the data. It will be interesting to see whether this furor raises calls to create standards such as those proposed by New York Attorney General Andrew Cuomo and the New York state legislature. My bet is that such state-driven guidelines are likely to pop up in other states soon, and I'm betting Tennessee will be no exception.

To learn more about this controversy:
- read this article from The Tennessean

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Cigna hires NCQA to check its doctor rankings

Mon, 10 Mar 2008 07:59:58 -0400

Over the past few months, New York Attorney General Andrew Cuomo has been challenging the physician ranking programs state health plans use. To make peace with the AG, the health plans have agreed to several guidelines for ranking physicians--including hiring an outside "ratings examiner" that would make sure that its physician grades were fair. Now, Cigna hired the the National Committee for Quality Assurance to oversee its program, a move that sets the quality bar high for its competitors and arguably, could expand the overall mission of the venerable quality group. NCQA execs also have said that they expect to announce that they'll be overseeing ratings for several other health plans, as those health plans arrive at final settlements with the state. In the meantime, Cigna's initial review by NCQA should be finished by late May.

What's interesting about this is that with NCQA involved, the New York settlements will have wide ripples nationally. For one thing, NCQA standards will bleed over into rating programs Cigna and others use elsewhere in the country. Meanwhile, since NCQA has a strong employer constituency, its involvement is likely to raise employer understanding of the process. This could prove to be a real turning point in the whole rankings movement.

To find out more about the NCQA's role here:
- read this Modern Healthcare piece (sub. req.)

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