Saturday, April 7, 2007

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.

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