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Inaccuracies In Insurers' Performance Data Raise Concern Among Physicians

Armen Hareyan's picture

Physicians who have been rated on quality care and cost efficiencystandards say data used to create the ratings often are incorrect andphysicians often have no way to correct them, the Washington Postreports. In an effort to contain rising health care costs, insurers andemployers increasingly are using programs that track physician qualityand efficiency data.

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Under the programs, physicians are ratedusing billing data, health records and software systems. The datasometimes are posted online for consumers' use. While the programs andsystems vary, physicians who perform well are usually added to a listof preferred providers. Physicians who have low rankings can be removedfrom the network or their patients can be charged higher copayments.More than 100 insurance companies nationwide have adopted suchprograms, according to the Post.

However, the Postreports that the trend shows how physicians "are at risk of losingcontrol of their reputations as corporations and other organizationsmine electronic data to draw conclusions about them and post themonline." Physician profiling programs have "spurred a lawsuit inSeattle, a physician revolt in St. Louis and a demand by a stateattorney general that one insurer halt its planned program," the Postreports. Some critics maintain that the effort is more about cuttingcosts than improving quality and enables physicians to "cherry pick"healthier patients whose problems cost less to treat.

Proponentssay the data encourage patients to use physicians that provide adequateand effective care at reasonable prices, while giving incentives tophysicians to improve care. "The data may not be perfect. But they'rebetter than any data that we've had before," according to DoloresMitchell, executive director of the Massachusetts Group Insurance Commission (Nakashima, Washington Post, 7/25).

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