Physicians

PHYSICIANS: Your data is wrong!

Read this article from the Dallas Morning News called Insurers’ ratings often aren’t accurate, doctors complain. It’s very very important, in that it explains both what’s wrong with using claims data to do analytics without working a little harder than most insurers want to, and also how the AMA is gearing up to beat back P4P, physician segmentation, Consumers checkbook and everything else in one simple phrase.

"Your data is wrong and I’m a good doctor"

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lindapriceShelleykilroyRWPeter Recent comment authors
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lindaprice
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lindaprice

i think this is relative.maybe ur both right
http://lindaprice.wordpress.com/

Shelley
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How to Fix the United States Health Care System We Must Do It Ourselves “Problems cannot be solved at the same level of awareness that created them.” –Albert Einstein Identify the Components: Ones That Work and Ones That Don’t The first step to solving any seemingly daunting problems is to break it down into component parts, identify what works about the existing status; and what doesn’t. It’s crucial to learn from the past. As a physician and owner of a solo practice (small business) I’ve experienced the health care system from all sides. I’m intimately familiar with how Medicaid, Medicare,… Read more »

kilroy
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kilroy

The doctors in this article conveniently neglect to mention how often the claims errors come out of their own offices. They miscode, mismark and otherwise bollix up their own records and then blame the insurers. I would be a little more sanguine about their objections if they would just agree on some kind of performance gauge. But these guys push the pens that drive costs up and have no accountability for either cost or quality (except in court and they complain about that, too). Let’s reform health care by using tax dollars to put deserving students through med school so… Read more »

rebecca
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True if no one is using the ratings it doesn’t matter too much – but people are and there is more and more pressure to tie financial incentives to quality/efficiency measures. And in the past tiered networks were being decided based on that criteria – a fad which thankfully seems to have run its course.

RW
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RW

This is pathetic. What other service would we pay so much for, risk so much for, and expect so little in terms of quality, accountability, measurement, or outcomes. Just because measurement is problematic doesn’t mean its not important to measure. Doesn’t the fact that no one has a way to satisfactorily measure medical “quality” bother anyone?!
Of course, my doctor is excellent. Just ask him.

Peter
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Peter

Well said docanon. Monitoring care is something for fraud and financial auditors and hospitals and doctors interested in best practice. Is it really something patients should be required to evaluate when even the “experts” can’t get it right? Get the medical guild to just do its job.

docanon
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docanon

I have trouble believing patients ever really look at health plan ratings of doctors with anything other than suspicion and mistrust…if they look at all. Massachusetts has some of the most aggressive physician profiling in the country, and I’ve never met a patient who paid any attention to it. The Hospital Quality Alliance has been posting hospital ratings since 2004…has anyone ever met a patient who based a decision on information it contains? Sure, there are all kinds of well-known problems with claims data (not to mention mathematical problems with collapsing dozens of independent measures of cost and quality into… Read more »

Barry
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Barry

This is nothing new, physicians have disagreed with claims data for years. Claims data has its faults, that’s for sure, but it may be the only encounter data that is readily available.

Lex
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I’m a newcomer to this blog. Why are all the posts but this one struck through? Did someone just forget to close a tag, or is there something else afoot? Thanks.

rebecca
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Oh how true this is. There are numerous ways in which claims data can be inherently misleading. With issues of identifying what happens in the hospital, the accuracy of physician and hospital diagnosis or procedure coding, even the clarity of interpretation of quality metrics, not to mention the ability of the insurer to accurately assign the responsible physician and their specialty. Coordination of Benefit issues, the fairness of holding doctors responsible for the insurer’s negotiated rates with providers (when typically they have little information or control over this), volume issues, stability of efficiency ratings from year to year. It makes… Read more »