Rating Doctors

Dear Friends and Colleagues:

Attached you find an interesting editorial from todays New York Times
The editorial highlights a disputed issue: how shall doctors performance be assessed and ranked.
An investigation by New York's attorney general has concluded that existing doctor-rating systems are based solely on the cost of care NOT on its quality.
Under a negotiated agreements with several major insurers, including Aetna, Cigna, United Healthcare and Empire Blue Cross/Blue Shield, a more user-friendly rating system should be developed that includes quality as measured by national standards and guidelines.

"Insurance companies have to make public what factors are included in their ratings and reveal how much weight they gave to cost in any composite score. An independent monitoring organization, approved by the attorney general, must oversee the process.
From a consumer’s perspective, it would be much better if the insurance companies all turned over their data to an independent organization to combine the results. It would be even better if evaluations also included such information as whether a doctor has been disciplined by state medical boards or has paid a large number of malpractice settlements."

This agreement may serve as a model for other states and organized medicine should proactively participate and contribute to the development of a rating system that empowers healthcare consumers to make informed decisions regarding their doctors choice.
Looking forward to your comments and critique.

Happy Holidays,

Yours

Bernd




December 8, 2007
Rating Your Doctor, Fairly

The drive to give consumers more information about the quality of their doctors has gotten an important shove forward by New York’s attorney general, Andrew Cuomo. That could be good for patients in dozens of states across the country that are served by some of the major health insurance companies.

An investigation by Mr. Cuomo’s office found that various doctor-rating systems currently used or planned by insurers are based primarily on the cost of care, not its quality. Doctors may be awarded a grade or stars, much like a restaurant or movie review, if they routinely treat sick patients for less than their competitors do. With that information, employers are able to steer their workers to lower-cost doctors by reducing deductibles or co-payments for those who patronize them.

Unfortunately, insurers seldom make clear just how they come up with their ratings, and there is no guarantee that the cheapest doctors are necessarily the best choice. Now the attorney general’s office has negotiated agreements with several major insurers, including Aetna, Cigna, United Healthcare and Empire Blue Cross/Blue Shield, that should make the ratings systems more useful to consumers and fairer to doctors.

Under the agreements, if insurers rate doctors, they cannot rely solely on cost but must also include quality as measured by national standards and guidelines. They have to make public what factors are included in their ratings and reveal how much weight they gave to cost in any composite score. An independent monitoring organization, approved by the attorney general, must oversee the process.

This approach has been endorsed by consumer advocacy groups, such as Consumers Union and the National Partnership for Women and Families, as well as the American Medical Association and the Medical Society of the State of New York.

Even with the improvements, ratings systems run by insurance companies may fail to provide consumers with the best possible information because they are based solely on the experience of that company’s subscribers. That may provide only limited insight into a doctor’s performance. Some doctors who participate in more than one insurance plan have received different ratings from different plans.

From a consumer’s perspective, it would be much better if the insurance companies all turned over their data to an independent organization to combine the results. It would be even better if evaluations also included such information as whether a doctor has been disciplined by state medical boards or has paid a large number of malpractice settlements.

Ideally, there should be a single Web site where consumers can get all the information they need to judge the quality of a doctor’s care and its cost-effectiveness.