Medical societies seek to improve physician tiering used by insurers

CHICAGO – The American Medical Association and 47 state medical societies, including those in Rhode Island and Massachusetts, are urging major insurers to take immediate action to improve the accuracy, reliability and transparency of physician ratings and tiering systems.
In letters delivered last week, the groups also called on insurers to publicly document the processes they use to classify doctors by submitting their programs for external review by unbiased, qualified experts.
“Patients should always be able to trust that insurers are providing accurate and reliable information on physicians,” said AMA President Dr. Cecil B. Wilson in a statement. “Studies show that economic evaluations of individual physicians are so unreliable that they are more often wrong than right.”
The doctors’ groups cited recent studies by the Rand Corp. that identified major problems with physician tiering and rating systems.
One, focused on Massachusetts, found that 17 to 61 percent of physicians would be assigned to a different cost category depending on which method an insurer used. Another, by the same authors and also focused on the Bay State, looked at cost profiles by specialty and found overall, 59 percent of doctors had scores with “suboptimal” reliability, with the most dramatic problems involving vascular surgeons.
In May 2008, the Massachusetts Medical Society and five physicians filed a lawsuit against the Massachusetts Group Insurance Commission and two of its participating health plans, asking the courts to “right the wrongs” inflicted by the commission’s physician tiering program. The suit is still pending in the Massachusetts Superior Court.
In a news release, Dr. Alice Coombs, president of the Massachusetts Medical Society, hailed the nationwide effort to call insurers to task for their physician classifications.
“The studies by the Rand Corporation demonstrate beyond any reasonable doubt that these tiering programs are flawed to their core,” she said. “These systems do not accurately measure a physician’s performance and should not be used to report on the cost performance. They mislead patients and unfairly impugn the reputation of a great many physicians. In some specialties, the accuracy of such programs is no better 50-50.”
“We support holding physicians accountable for the quality and cost efficiency of their care,” she added. “Accurate and reliable data will only help us and our patients with improving care. Let’s work toward that goal together.”
The letter is available online.