Outcry builds over doctor-rating project

A large health system in St. Louis threatens to drop UnitedHealthcare to protest the program's unfairness.

By Robert Kazel, AMNews staff. April 11, 2005.

A new pilot program by UnitedHealthcare that purports to measure physicians' quality and efficiency, and that penalizes some patients who are treated by doctors not designated as "performers," continues to spur a backlash.

One example was the decision by the largest health system in St. Louis to drop out of United unless it agreed to revamp or scrap the initiative.

BJC Healthcare, parent company of Barnes-Jewish Hospital and nine other St. Louis-area hospitals, announced March 17 that it planned to terminate its United contracts Aug. 13 because only 18% of its approximately 4,000 doctors had been deemed "performance" physicians by the UnitedHealth Performance Program, which rolled out in January.

The insurer has told doctors that the program is sound despite many physicians' outrage over ratings they believe are based on a questionable measurement system and their resentment that they had no influence in the project's design, said Steven Lipstein, BJC president and CEO.

United's analysis of patient claims data misleads patients because the "performance" designations for many specialists are based only on cost, not quality, Lipstein said. In addition, many doctors were denied recognition due to inherent weaknesses in how the insurer does its measurements, he said.

One major flaw is that United won't assign a "performance" rating unless it has claims data on 10 patient encounters filed by an individual doctor, he said. That requirement might have little to do with how claims are filed, he said, pointing to about 1,200 physicians on the Washington University Medical School faculty who bill the insurer as a group. For the most part, they did not receive recognition as "performers," he said.