Docs and Insurers Posture on Report Cards, But Is Silence the Real Goal?

Millenson  Report cards are back in the news.

The Washington Post (via Kaiser Health News) is warning about the difficulty of rating individual physicians. Meanwhile, spokesmen for the insurance industry and the doctor industry (a/k/a the American Medical Association) are content with huffing and puffing about the perfidy of any report card that’s about them.

 In late July, for instance, the AMA sent letters to more than 40 health insurance companies requesting they investigate the reliability of their physician rating programs in the wake of RAND studies casting doubt on how low-cost and high-cost doctors are classified and on some quality rankings. That work was partly funded by the AMA and the Massachusetts Medical Society, which is also suing the Massachusetts Group Insurance Commission (GIC) over its physician ranking effort.

I'd have more sympathy for the docs except for the fact that the GIC effort has actually been one of the most intensive in the country to take into account quality as well as cost. Moreover, GIC executive director Dolores Mitchell has been a fierce pro-consumer advocate, not a role typically filled by your local medical society. (One local profile called her a “change agent” who “doesn’t take any guff.) And despite the complaints, there has been very little effort by the AMA or most other medical societies to work with insurers to provide the kind of timely clinical data (as opposed to claims data) that would make report cards more useful to patients.  The search for the perfect is too often a deliberate tactic to delay the implementation of the good.


But at least when it comes to objecting to cost comparisons of individual physicians, the docs have the facts on their side. The insurers, in contrast, win the chutzpah award for their reaction to the federal government’s healthcare.gov website. In response to the government’s plan to show how often insurers deny claims, America’s Health Insurance Plans (AHIP) sent a letter to the government claiming, in effect, that the report card needed to be risk-adjusted for doctor stupidity.

Join me please, in reading between the lines in this story from the Los Angeles Times : 

“’Providing information about claims denials without providing proper context does not begin to tell the whole story,’ said Robert Zirkelbach, a spokesman for the group, who said claims are often denied because a provider sent a duplicate claim or submitted a claim to the wrong health plan.”

The seeming logic of this objection falls apart completely on closer inspection. The reality is that the same doctors are on the panels of virtually all health plans in most markets. If one plan’s denial rates are higher, the reason is either the physicians (and their staff) are dumber when they fill out only that claim form or that claim form is more difficult to fill out or that health plan's policies actually result in denial of more claims – the latter two possibilities meaning the plan has earned its bad grade. The same holds true if a provider that dominates one market gets a much lower grade than a provider that dominates a different market. Again, it’s either the fault of the insurer or – to paraphrase AHIP– it’s because “my doctors are dumber.”

 The unfortunate reality is that today’s report cards still only scratch the surface of what patients want to know and deserve to know, as St. Louis Post-Dispatch reporter Jeremy Kohler makes clear in an Aug. 1 account, trying to track down the details after being tipped off about a wrong-site surgery at a local hospital. His piece is entitled, “Serious Medical Errors, Little Public Information.” Indeed, patients continue to fight just to see their own medical information , much less information on doctors.

When it comes to patient safety and quality, a deadly silence , alas, too often continues.

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