July 25, 2007

No smiley face for rating systems

Filed under: — mlazoff

An article in today’s Washington Post, Doctors Rated but Can’t Get a Second Opinion: Inaccurate Data About Physicians’ Performance Can Harm Reputations, ”raises questions about the line between responsible oversight and outright meddling in the relationship between caregivers and their patients.”

The journalist discusses the benefits and problems with computerized rating systems, which are currently used by more than 100 insurance industry markets or regions across the country, including the entire state of  Massachusetts. “Physician profiling relies on the growing practice of creating electronic medical records. Once kept only on paper, records about patients, doctors, hospitals, pharmacies and other caregivers are increasingly aggregated in giant digital storehouses…Doctors are rated on standards of quality of care and cost efficiency. An internist, for example, gets higher ratings on quality if he puts his heart attack patients on beta blockers, a medicine that reduces the workload on the heart, or if diabetic patients are tested for blood-sugar control…The systems differ. A doctor who performs well might be awarded stars, a smiley face or a Tier 1 rating. An inferior doctor’s patients might receive higher co-payments, or the physician might be shut out of an insurer’s preferred network…Such data-driven surveillance offers the prospect of using incentives to steer patients to care that is both effective and sensibly priced.” 

Or “steer” patients to neither. The trend towards physician ratings based on performance on selected quality indicators, “which parallels a push by President Bush to promote consumer access to information about health-care quality and cost, has spurred a lawsuit in Seattle, a physician revolt in St. Louis and a demand by a state [New York] attorney general that one insurer halt its planned program.”


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