Corporate group turns to doctor rating system

Companies band together to monitor physicians' performance as a way to control insurance costs.

By Robert Kazel, AMNews staff. April 26, 2004.

A coalition of 28 large employers intends to create report cards grading physicians on quality and cost efficiency, and will use the scores to try to persuade patients to select doctors who score the best.

The grades could be used to undergird pay-for-performance incentives or tiered physician networks, in which patients' co-payments or co-insurance differ depending on physicians' good or bad marks.

The initiative, Care Focused Purchasing, includes J.C. Penney Corp.; the Pepsi Bottling Group; Sears, Roebuck and Co.; Sprint Corp.; Texas Instruments Inc.; BellSouth Corp.; and Xerox Corp.

The data for assigning grades will come from coalition employers as well as from insurance companies that agree to be affiliated with the coalition. So far, CIGNA Corp., Humana Inc. and Empire BlueCross BlueShield of New York have signed on to the program. Other plans are in discussion with the coalition, said Eric Grossman, a principal with Mercer Human Resources Consulting. Mercer helped organize the coalition over the past year.

Quality measures would look at the past two years of claims and would be based on how well doctors have adhered to evidence-based treatment protocols already issued by specialty medical societies or other organizations such as the National Committee on Quality Assurance, Grossman said. A panel consisting of physicians, primarily from academia, and medical officers from several large health plans will come up with a set of quality and efficiency standards that doctors will be expected to meet.