QUALITY INDEX: PacifiCare Grades Questioned By Some Doctor Groups
Just a little over two weeks since PacifiCare Health Systems Inc. released its " quality index" rating doctor groups on the clinical care they provide and patient satisfaction, some physicians are decrying the data as flawed. The Sacramento Business Journal reports that the index's grades for HMOs varied "widely." Dr. Gary Fields, medical director for Sutter Medical Group said the report card "had to be taken with a grain of salt," noting that his group only scored one or two percent on mammograms. And Dr. John Young, president of the MedClinic Medical Group, said, "It's a first good cut, but I'm not totally convinced it's accurate." He explained that the data used for the report card "comes predominately from billing and claims data, and medical groups that collect a set fee per member ... under managed care don't enter everything they do as a claim." PacifiCare's medical director, Dr. Gordan Norman, conceded, "Just doing this is controversial, but the time has come to present the material, even if it is not perfect." He noted that the report card is in response to consumer demand for such information. Steve McDermott, executive director of Hill Physicians Medical Group Inc., said the report cards will help doctors to do a better job. "Doctors are egotistical, competitive people who make it through medical school on the basis of being scored and rated. They don't like poor scores," he said.
Winners And Losers
In the Sacramento area, the report surveyed nearly 94,000 PacifiCare members. They were asked to rate medical groups in "14 categories ranging from clinical measures like cervical cancer screening to service matters like benefit appeals." Some of the widely varying grades include:
- Sutter Medical Group received a 95% for "overall member satisfaction," but "scored dismally" on its mammogram record.
- Sutter Independent Physicians pulled a 92% for providing "good data on the number of procedures doctors do monthly, but bombed on cancer screenings."
- UC-Davis Medical Group scored 94% for providing mammograms but many of its seniors complained about access.
- MedClinic Medical Group got 91% in "member satisfaction," but had its seniors complaining about access as well.
- Hill Physicians earned 93% for "appropriate treatment of seniors with congestive heart failure," but had significant numbers transferring out of the plan because of "dissatisfaction" (Robertson, 9/14 issue).