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Life Health > Health Insurance > Health Insurance

Doctors: Quality Rating Programs Need a Workup

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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.”

The groups are calling on carriers to re-examine their doctor evaluation methods and have impartial outside experts review their approaches to ratings.

Karen Ignagni, president of America’s Health Insurance Plans (AHIP), Washington, says she disagrees with the RAND researchers’ findings. The RAND study focused on efforts to assign physicians to high-cost and low-cost tiers in a 2-tier system.

“Quality, which includes patient satisfaction, is the most important factor used to create value-based networks for patients,” Ignagni writes in a letter to Steve Ellwing, director of physician advocacy at the AMA. “Unfortunately, this research didn’t take this into account.”

Ignagni says researchers need to do more studies on strategies for measuring and evaluating the performance of physicians and other providers.

“AHIP and its members have a long history of working collaboratively with providers and other stakeholders, and we are committed to continuing these collaborations to ensure reliable and accurate provider performance information,” Ignagni says.


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