Physicians Wary of Ratings Based on Inaccurate Data
Physicians who have been rated on quality care and cost efficiency standards say data used to create the ratings often are incorrect and physicians often have no way to correct them, the Washington Post reports.
In an effort to contain rising health care costs, insurers and employers increasingly are using programs that track physician quality and efficiency data.
Under the programs, physicians are rated using billing data, health records and software systems. The data sometimes are posted online for consumers' use. While the programs and systems vary, physicians who perform well are usually added to a list of preferred providers. Physicians who have low rankings can be removed from the network or their patients can be charged higher copayments. More than 100 insurance companies nationwide have adopted such programs, according to the Post.
However, the Post reports that the trend shows how physicians "are at risk of losing control of their reputations as corporations and other organizations mine electronic data to draw conclusions about them and post them online."
Physician profiling programs have "spurred a lawsuit in Seattle, a physician revolt in St. Louis and a demand by a state attorney general that one insurer halt its planned program," the Post reports. Some critics maintain that the effort is more about cutting costs than improving quality and enables physicians to "cherry pick" healthier patients whose problems cost less to treat.
Proponents say the data encourage patients to use physicians that provide adequate and effective care at reasonable prices, while giving incentives to physicians to improve care.
"The data may not be perfect. But they're better than any data that we've had before," according to Dolores Mitchell, executive director of the Massachusetts Group Insurance Commission (Nakashima, Washington Post, 7/25).