Medical societies cheer over flaws found in physician rating programs

"Physician ratings conducted by insurers can be wrong up to two-thirds of the time for some groups of physicians," concluded a RAND Corporation study published in today's New England Journal of Medicine. RAND analyzed insurance claims submitted by 13,788 Massachusetts physicians to four health plans in 2004 and 2005 and determined that most physicians "did not have cost profiles that met common thresholds of reliability."

In particular, researchers found that 50 percent of internists, 66 percent of vascular surgeons, 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.

These findings validate the American Medical Association's longstanding criticism of methods health plans use to rate physicians' quality based on the cost of care they provide. "Given the potential for irreparable damage to the patient-physician relationship [due to inaccurate quality information], the AMA calls on the health insurance industry to abandon flawed physician evaluation and ranking programs, and join with the AMA to create constructive programs that produce meaningful data for increasing the quality and efficiency of healthcare," said J. James Rohack, MD, AMA president.

Physician ratings, or tiers, have also been under close scrutiny by the Massachusetts Medical Society, which publishes NEJM, and in 2007 adopted its own set of principles for physician ranking programs. MMS is also currently in litigation with the Massachusetts Group Insurance Commission and two of its participating health plans, seeking to "correct the wrongs" in its tiering program.

As to the RAND study, Mario E. Motta, MD, 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."

To learn more about the AMA's reaction to the RAND study:
- read the abstract of the RAND study in the NEJM
- read the AMA's reaction to the study
- here's MMS' response to the study
- learn more about MMS' principles for physician ranking

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.