PHYSICIAN PROFILING: United’s First Findings
A United HealthCare Corp. study of its physicians' compliance with medical practice standards shows doctors may be failing to prescribe some essential prescription drugs and perform diagnostic tests. United medical director Dr. Lee Newcomer said he was "absolutely blown away" by the results of the HMO's continuing investigation into how the 200,000 doctors in its network deliver care in key specialty areas, the Wall Street Journal reports in a front-page story. "Mediocre is the best word that describes this clinical performance," he said. The study, which began by examining 1,600 cardiologists and internists, found that many doctors "failed to prescribe widely recommended drugs such as beta blockers for heart-attack survivors and 'ACE inhibitors' for chronic heart-failure patients." A "startlingly low" number of patients with atrial fibrillation got the anticoagulants they needed -- between 12% and 25%, the research found. Ohio internists performed "glycated hemoglobin" glucose-monitoring tests on only 59% of diabetic patients in one year, but University of Chicago diabetes specialist Kenneth Polonsky said all diabetics should have the test done annually. In other survey findings, between 74% and 78% of women ages 52-64 got a mammogram, a number some radiologists called "impressive."
Saving Patients, Saving Money
United is expanding its study, and will use the information "to get doctors to do more tests and provide more drugs" to patients who need them. "I can buy a lot of beta blockers by avoiding the cost of treating a second heart attack," Newcomer said. When the investigation wraps up, United will make its findings available to its 10.4 million patients nationwide. But some doctors are unhappy with United's research. "I wonder if they're going to use this information against me," said Greensboro, NC, cardiologist Dr. Spencer Tilley Jr. "The managed care industry has not created an atmosphere of trust ... Managed care people don't care about the doctors. Nobody does," he said. United says it only wants to help doctors, not punish them -- a statement doctors have a hard time believing. "It's like when the IRS comes in and says they want to help you," said Dr. James Weissman, also of Greensboro, NC.
Newcomer said United's study, which uses the company's computerized database and pharmacy bills, "isn't a perfect system." But the Journal reports that physicians "raised only minor quibbles over accuracy." Plano, TX, cardiologist Dr. Waenard Miller said "United HealthCare did something that is important. And they did it in a nonthreatening way."
A Bigger Trend At Work
The Journal reports that "in the absence of a government spotlight, some American corporations and insurers have begun to wield their market clout to force hospitals to divulge their surgical success rates -- and then they use those findings to adjust payments to the hospitals." Heading up this trend are the Pacific Business Group on Health and Anthem Blue Cross and Blue Shield. United HealthCare's physician profiling efforts are "[a]mong the most advanced efforts" by managed care companies, "although some view its work as just the first step." Michael Pine, a Chicago-based medical consultant, said: "This is a reasonable place to start, because holding up a mirror to medical practice is a step forward. But the issue ultimately isn't the prescribing of ACE inhibitors. The issue is who is giving the best treatment of heart failure" (Burton, 7/8).