Doctors: Quality Rating Programs Need a Workup

The American Medical Association (AMA) and over 40 state doctor groups are complaining about the quality of health insurers’ methods for rating provider quality.

In a letter addressed to top executives of 47 health insurers, the AMA, Chicago, and affiliated state physician organizations complained about physician rating systems “that use opaque methodologies and report inaccurate results.”

The AMA “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,” the groups write in the letter, which is addressed to the chief executive officers and chief medical officers of health plans around the country.

The groups cite a recent study by RAND Corp., Santa Monica, Calif., that concludes that the physician ratings used by health insurers are largely inaccurate.

Profiling systems used to measure physician reliability are “Rube Godbergesque” and “error-plagued,” according to the lgroups. The groups say insurer ratings systems are damaging physician reputations with “unscientific methodologies and calculations.”