Companies Join Doctor-Rating Act
APRIL 2004
This month the AMNews reported that a corporate group of 28 large employers formed a coalition to control insurance costs. The group intends to create a report card grading physicians on quality care and cost efficiency in order to persuade patients to select doctors who scored the best.
The “Care Focused Purchasing” initiative includes employers such as J.C. Penny Corp, Pepsi Bottling, Sears, Sprint, Texas Instruments, and Xerox, as well as affiliated insurance companies such as CIGNA, Humana, and Empire BCBS of New York.
A panel comprising physicians (primarily academic) and insurance company medical officers will devise a set of efficiency standards that the coalition will expect doctors to meet.
The coalition will review the past two years claims (data provided by employers and insurance company coalition members) to assign grades by two measures; quality and cost efficiency.
For quality measurements, the coalition will evaluate the physicians on how well they have adhered to evidence-based treatment protocols already issued by specialty medical societies or other organizations such as the National Committee on Quality Assurance. For cost-efficiency, the coalition will evaluate doctors across the spectrum of the treatment of the patient’s condition and said they will not judge effectiveness based on unit cost.
The coalition expects that employers and health plans may use the report card for physician incentive pay programs, they may place doctors in different tiers within networks, or they may simply publish lists of doctor’s names with “star” or numerical ratings. The coalition suspects that some insurers will begin to use the grading system in new product designs as early as next year.
In an effort to counter physician-rating activities which will undoubtedly be cost-based, ORA has commissioned a patient insurance satisfaction survey. It will similarly grade Oregon insurance companies such as CIGNA and Regence, on how their coverage affects the quality of care provided arthritis patients.
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