Tuesday, August 21, 2007

Roll-back of insurer rating systems?

On my favorite topic, reporting of clinical results, Theo Francis at the Wall Street Journal talks about ranking of physicians by insurance companies:

Doctors and regulators are pushing back against rating systems that some health insurers have developed to guide consumers in choosing physicians. New York Attorney General Andrew Cuomo demanded last week a "full justification" of the rankings that Aetna Inc. and Cigna Corp. have rolled out in the state. He warned the companies that the ratings are confusing and potentially deceptive, in part because insurers don't disclose how prone to error their rankings are. The move follows rankings lawsuits by doctors accusing insurers of libel, unfair business practices and breach of contract in other states.

A number of insurance company people here in Massachusetts had raised similar concerns with me, stating that any ratings they produced would be viewed as self-serving by members of the public. So, I guess this throws the ball back into the court of the public agencies. (Or, of course, providers could self-report on an insurance company website that was open to all.)


Anonymous said...

I'm sure rating systems can unduly penalize perfectly good doctors, that doesn't seem right. However as a consumer its helpful to have some way of deciding. A persons health shouldn't be left to, eeny meeny miny mo (a shot in the dark doctor). Perhaps more transparency, initiated by the doctors would give them more control and us (consumers) more information.

Anonymous said...

As far as I know, the Commonwealth's Group Insurance Commission, which pays health insurance for all state employees, has not abandoned its ranking system.

Anonymous said...

We (patients, doctors, employers and the insurance cos) are paying the price for the widespread distrust in this country of anyone perceived, accurately or not, to have a conflict of interest. (Your suspicion of the phone survey in your previous post, Paul, is another example of such distrust.) Frankly, I suspect the insurance companies ARE doing these rankings based largely on cost, and the quality issue, while it may be accurate, is the baby thrown out with the bathwater. I heard one story of a doctor whose rating was lowered because he didn't perform pap smears on all his female patients, even those who had had hysterectomies. Such is the data quality provided by billing alone.

Yes, public agencies or respected groups like the Institute of Medicine might be the best avenue for trusted data. I just don't see any of the stakeholders developing sufficient trust.

Anonymous said...

Well, there are a lot of problems with the GIC ranking. For one thing, the clinical data are really out of date. For those concerned about cost, it is indeed a factor in their ranking, as well.

Anonymous said...

My sense is that physicians are too sensitive about insurer rankings. God save us if we have to rely on the GIC.If Charlie Baker and HP decided to publish quality listings, I would have confidence that the info would have accurate and helpful guidance for patients and be more up-to-date than any government source. Also, there ought to be on-line forums/blogs where hospital patients (inc. BI) can report their experience. I recently had my second hip surgery at BI, have a high regard for the surgeon, and would like to be able to say so in a forum that might be helpful to other patients.

Anonymous said...

Paul -

I must tell you that I have been absolutely delighted by the ease with which your organization has helped me work through an elective issue. My PCP appointment was scheduled quickly and conveniently at night, the x-ray I required was done within 15 minutes of completion of my exam, and I scheduled another (at night) MRI by telephone in five minutes for the next day. My doctor was professional and cordial. Everything has been terrific, and far different from the experiences I subjected my patients to during my own medical training. Kudos for practicing what you preach: it's nice to see a U.S. hospital treat me like a client at the same time as listening to and caring for my medical needs as a patient.

Anonymous said...

Thanks to both Ed and Dave. We keep trying, and it is not easy to do this stuff consistently well -- especially the customer service aspects. I appreciate your taking the time to write.

Johnnysmooth said...

Unfortunately, what I am seeing is a lot of different actors coming on stage to rank physicians/providers. You have GIC, some of the recent efforts by CMS, there are payers/insurers, some employers on their own or through Leapfrog. Where is a citizen to turn, what is a citizen to trust?

Granted, the healthcare sector is anything but transparent to Joe or Jane Citizen and I don't have any easy answers. But what we have today is a rat's nest of at times competing motivations and rankings. Maybe it is time for Consumer Reports to grab the reins.

Anonymous said...

For the past several years, I've advocated the creation of some kind of "Bureau of Health Statistics" at the state level to collect and disseminate information on health care cost and quality - kind of like the national Bureau of Labor Statistics. Everyone can access the data - and use it as they wish. Some people suggested I was passing the buck from myself - at Harvard Pilgrim - to the government, and that HPHC should do it if I thought it made sense. The AG's behavior in NY is exactly why I believe a single source of "truth" needs to come from a public entity.

We have the beginnings of one of these kinds of organizations with the creation in MA of the MA Health Care Quality and Cost Council. But it's slow going, to be sure.

As far as the GIC is concerned, I think the tiering that's been done by the plans has been done with the best of intentions and with the best available information. It's not perfect, but it's not all old, and it's not all bad - and for the most part, the tiering is relatively mild. Most physicians and hospitals are tier one providers, and there are only two tiers, with modest financial incentives to the member between tier one and tier two. If the data gets better over time, maybe the tiering gets more precise or the member cost-sharing grows between tiers.

But the health care sector needs to be more transparent. The same procedure done the same way for the same person with the same outcome can vary in cost by as much as 300 percent - and nobody knows it and nobody cares. No wonder it's so expensive!!

And many thanks, Ed, for your kind comments about me and about Harvard Pilgrim. Very much appreciated.