The American Medical Association (AMA) and 47 state medical societies have fired off a letter to some of the nation's largest health insurers, asking them to improve their physician cost profiling methodology, reports the Chicago Tribune. The request follows the release earlier this year of a RAND Corp. study that determined physician profiling methods commonly used by insurers result in "22 percent of physicians being assigned to the wrong cost category in a two-tier system." In other words, insurers aren't always accurately assessing which physicians actually have lower spending patterns.
The letter asked health plans "to formally re-evaluate your physician rating program(s) and demonstrate that they are reliable, accurate, and valid; drive quality improvement efforts; and address the concerns raised in RAND's research findings," reports MedPage Today.
"This re-evaluation should include an external review and assessment of the program's misclassification rates by unbiased, qualified experts and also consider whether these programs or alternative strategies are needed to improve quality and system efficiency," the letter continued. "While we understand and support health insurer and payers' desires to provide the public with information on high quality and efficient healthcare, the AMA and the Federation of Medicine cannot support payer programs designed to steer patients to certain physicians and practices based on inaccurate physician ratings or primarily on physician cost of care profiles without regard to the quality of the services provided."
However, America's Health Insurance Plans (AHIP) isn't sure that the RAND study does in fact plug into how health insurers conduct physician profiling. "Specifically, health plans base their assessments both on quality and cost as opposed to these analyses, which focused solely on costs," AHIP president and CEO Karen Ignagni wrote in a letter responding to the AMA, reports MedPage Today. "Quality, which includes patient satisfaction, is the most important factor used to create value-based networks for patients. Unfortunately, this research didn't take this into account."