Tiered physician network pits organized medicine vs. United

Pressure from doctors has the plan rethinking its methods, but many say the number of insurers grouping physicians on cost and quality will only increase.

By Robert Kazel, AMNews staff. March 7, 2005.

Al Elbendary, MD, a St. Louis ob-gyn, gets a star by his name on the UnitedHealthcare Web site. He does not consider it an honor.

Dr. Elbendary got the notation because United considers him a "performance" physician. Under a new plan United would manage for self-insured employers, patients get a discount on co-pays or other financial incentives if they see physicians determined to be cost efficient and high quality. The insurer deemed about one in four physicians in St. Louis worthy of "performance" status.

But to Dr. Elbendary, president of the St. Louis Metropolitan Medical Society, and other area physicians, there was nothing worthy about United's standards. The insurer's evaluation, he decided, was technically flawed, unfair to doctors, disruptive to patient-physician relationships, and more about saving the insurer money than promoting best practices. Physicians were rated on quality based on two- and three-year-old information from claims files. United's Web site notes that pediatricians, dermatologists, gastroenterologists, urologists, otolaryngologists and physicians in eight other specialties could not be adequately rated for quality -- so the sole factor was cost.

On Feb. 17, a letter -- signed by the American Medical Association, the Missouri State Medical Assn., the St. Louis Metropolitan Medical Society and the St. Charles-Lincoln County (Mo.) Medical Society -- implored United and one of its clients, General Motors, to drop the UnitedHealth Performance plan.