Massachusetts Medical Society Comments on RAND Study Critical of Physician Tiering Programs

Waltham, Mass. -- March 17, 2010 -- The Massachusetts Medical Society has commented on a new study released today by the RAND Corporation which, analyzing the use of physician cost profiling tools similar to those used by the largest employer in Massachusetts, concluded that the program misclassifies a significant number of the physicians profiled.

"Consumers, physicians and [health care] purchasers are all at risk of being misled by the results produced by these tools," the authors wrote.

"These finding bring into question both the utility of cost-profiling for high stakes uses, such as tiered health plan products, and the likelihood that their use will reduce health care spending," according to the authors of the study.

In reaching its conclusion, RAND obtained insurance claims submitted by 13,788 Massachusetts physicians to four health plans in 2004 and 2005. It analyzed the data to determine whether the profiles reliably reflected the physicians' actual cost performance.

 "The majority of physicians did not have cost profiles that met common thresholds of reliability," according to the report. "[For example] one half of internists and two-thirds of vascular surgeons were classified inaccurately as lower cost."

Similarly, 40 percent of cardiologists, 50 percent of endocrinologists and 58 percent of pulmonary and critical care specialists were inaccurately classified as providing lower-cost care.

Mario E. Motta, M.D., president of the Massachusetts Medical Society, said, "It's critically important that patients and physicians get clear, accurate information about the cost and quality of health care. But this report, produced by an independent, renowned research firm, clearly demonstrates that these profiling programs fail to accomplish those goals."

Dr. Motta said, "We are not opposed to public reporting, as long as it is done fairly and accurately. We remain committed to working with all parties to develop a reporting program that meets those basic standards."

Tiered health plan products have been adopted by several health plans across the country, in an effort to encourage patients to use cost-efficient, high-quality doctors. The Massachusetts Group Insurance Commission (GIC), which purchases health insurance for state employees and other public sector employees, has required its participating health plans to implement such tiered products since 2006. The Massachusetts Medical Society is in litigation against the GIC and two of its participating health plans, seeking to "correct the wrongs" of its tiering program.

The RAND study, funded by the U.S. Department of Labor, the National Institutes of Health and the Robert Wood Johnson Foundation, was published Wednesday in the New England Journal of Medicine.

The Massachusetts Medical Society, with more than 22,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country.