Medical Groups at Odds With Insurance Firms Over Ratings Systems
On Monday, the American Medical Association and medical societies in 47 states sent a letter to health insurers criticizing the industry's increasing use of physician grading systems, which they contend are "unreliable" and "unfair," the Wall Street Journal reports.
Grading systems typically divide health care providers into tiers based on several factors -- including cost, patient outcomes and quality -- and can lead insurers to charge patients lower out-of-pocket costs for choosing a preferred physician (Mathews, Wall Street Journal, 7/20).
Insurers -- including Aetna, CIGNA, UnitedHealth and WellPoint -- have been using such systems for up to six years.
Such grading systems likely will become more prevalent in the coming years. A provision in the new health reform law requires physician grading systems to be implemented by 2013 (Sturdevant, Hartford Courant, 7/19).
Employers eventually could rely more heavily on grading systems, as they look to cut costs while providing mandated minimum health benefits to their employees.
AMA in its letter cited "serious flaws" in insurers' methods for grading physicians (Wall Street Journal, 7/20).
For example, the group highlighted research from RAND showing that insurers' current systems are inaccurate up to 66% of the time, potentially jeopardizing a physician's reputation or relationship with a patient (Hartford Courant, 7/19).
The research also indicated that evaluations are overly subjective, target individual providers and fail to consider other variables, such as patients' health (Abelson, "Prescriptions," New York Times, 7/19).
The physician groups have said they are not attempting to get rid of the rankings but are seeking to have greater input (Hartford Courant, 7/19).
The groups also called for greater transparency and publication of insurers' evaluation methods ("Prescriptions," New York Times, 7/19).
Insurers contend that grading systems help control costs and satisfy consumer demand for physician quality measures (Hartford Courant, 7/19).
They also have said their ratings focus on physician groups -- not individual providers -- and appropriately provide incentives for patients to choose higher quality, more efficient care.
In a letter on Monday, Karen Ignagni, president and CEO of America's Health Insurance Plans, wrote that the grading systems fulfill employers' and purchasers' requests to reward efficient care. She added that the RAND research did not correspond with most insurers' physician performance measurements because it focused solely on cost instead of both cost and quality ("Prescriptions," New York Times, 7/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.