Health Insurers, Physician Organizations, Patient Advocates To Develop Standards for Rating Physicians

Physician groups and health insurers on Tuesday announced an agreement to develop national standards that the companies will use to rate physician performance, the New York Times reports. According to the Times, although health insurers "increasingly have been measuring doctors' performance through public report cards or designating tiers of physicians that try to steer people to certain doctors, so far, such rating efforts have been controversial," as physicians "complain that the health plans have focused too much on cost, without regard to the quality of care physicians actually provide, and that rankings are often inaccurate" (Abelson, New York Times, 4/2).

Under the agreement, the standards used to rate physician performance will separate quality of care and cost effectiveness measurements. Health insurers also will disclose the systems they use to rate physicians, inform physicians before they rate them and establish a dispute process to allow physicians to challenge their ratings (Cook, Houston Chronicle, 4/1). In addition, health insurers will allow independent groups to review physician ratings (New York Times, 4/2). The standards will rate physicians with a system of stars. The standards also will use different measures to rate physicians based on their specialties (Won Tesoriero, Wall Street Journal, 4/2).

The project, called "Patient Charter," has support from the American Medical Association, the American College of Surgeons, Cigna, Aetna, UnitedHealth Group, WellPoint, America's Health Insurance Plans, AFL-CIO, AARP and the National Business Coalition on Health (Houston Chronicle, 4/1). In addition, the project has support from General Electric, General Motors and the American College of Cardiologists. The Consumer-Purchaser Disclosure Project will lead the project, which has received funds from the Robert Wood Johnson Foundation (Wall Street Journal, 4/2).

Comments
Project spokesperson Jonathan Osmundsen said, "The framework is nailed down. It's the details where it starts to get sticky," adding, "Doctors, insurers, employers and patients all come at this from different perspectives, but they've agreed they have to generate fair rankings that are easily understood and actually useful" (Houston Chronicle, 4/1). Nancy Nielsen, president-elect of AMA, said, "Physician report cards will not be based on cost alone," adding, "We think this goes a long way to resolve some of the concerns" about current standards used to rate physician performance.

Aetna Chief Medical Officer Troyen Brennan said, "We're making changes right now to be able to comply" with the agreement, although the company currently uses a similar system (New York Times, 4/2). Jeff Kang, chief medical director for Cigna, also said that the company currently uses a similar system. He said, "Our approach has always been to look at total cost for an episode" (Houston Chronicle, 4/1).

Robert Berenson, a senior fellow at the Urban Institute, said, "I think the current measures for physician care provide a very limited snapshot of what physicians do," adding, "Too many eggs are put into the performance-measurement basket." Debra Ness, president of the National Partnership for Women and Families, said, "Right now, it's very hard for consumers to get very good information about the quality or performance of the health care system" (Wall Street Journal, 4/2). Peter Lee, executive director for health policy of the Pacific Business Group on Health, said, "There has been a hodgepodge of measures that patients don't know if they can rely on and doctors certainly don't trust" (New York Times, 4/2).