High quality or Low cost doctor?

There was an interesting article I came across on MSNBC:
Doctors angered by insurers' rating systems

It appears that many insurance companies are rating physicians. This "ratings" are then used to compensate physicians that they see as providing better care with bonuses or by having lower co-pays for patients to see these preferred doctors.

The insurance company says:

"We believe consumers should have information and access to all their doctors but we want to (give them incentives) to go to high quality providers," said Dr. Jeffrey Kang, senior vice president and chief medical officer at Cigna. Such products can lower health care costs by 3 percent to 5 percent, he said.

One physician response is:

"We're concerned that as insurers try to maximize profits they are saying that the doctor that charges the least amount of money is the highest quality," said Dr. Jim Rohack, a cardiologist who is an AMA board member.

The problem with the ratings are delineated in the article:
Some physicians were rated poorly for managing diseases that patients did not have.
If patients did not have tests that were ordered done, this would cause negative marks.

Other problems I see with this are the possibility that insurance companies can reward providers for spending less money (generic drugs) or avoiding ordering tests.

They can also lead patients to doctors that they pay less. Many people do not know this, but many insurance carriers pay different doctors different fees. This is different than the government (Medicare) that pays the same to all in a region.

If there were set criteria that were reliable, I would be fine with this system. As it is I doubt this is the case.

I wonder how much weight patients put on these preferred status.

Removing the wrong testicle

All the steps to prevent this wrong-site surgery went awry.

Source: Kevin, MD

This is the second time I remember Kevin MD finding wrong site surgery in my field, urology.

The last time was on a kidney:
http://www.njurology.com/RoboticSurgeryBlog/2006/03/removing_the_wrong_kidney.php

I read some of these comments and without taking sides, here are some facts:
The cancerous testicle should have been removed when he first has cancer. I am sure the physicians advised him of this many years ago.

As for all the risks he will be exposed to, they are inaccurate. The main problem with removing the incorrect testicle has to do with infertility. He will not be able to father his own children. He wanted a vasectomy, so this should not be as big of a deal as it otherwise would be.
The other side effects can be prevented with testosterone replacement.

Several of my testicular cancer patients are on testosterone for supplementation since their remaining testicle isn't producing enough anyways.

As for what amount is appropriate for compensating this poor gentleman, I guess that depends on how you look at it.

The last point I had a problem with is the patient saying he did not read the consent. I do not have my patients read the entire consent, but I do read the important points to them. They can read it if they want to.

Grand rounds is up at UroStream

UroStream: Grand Rounds Vol. 3, No. 28

Welcome!

I have the honor of hosting Grand Rounds for the second time! I can't believe it has already been a year since the last time I put all these great medical posts together. Time does indeed fly when you are blogging away.

I thought of many different ways to 'spice up' Grand Rounds. After much deliberation, I finally decided to' stick to the basics' and just present 'the facts', as I did many times before as a resident during our weekly nerve-wracking, anxiety-inducing Urology Grand Rounds.