Internists outline principles for quality ratings

The American College of Physicians sets out a detailed appeals process.

By Kevin B. O'Reilly, AMNews staff. June 4, 2007.

Physicians should be allowed to review quality ratings before payers publicize the data or use them to determine pay, according to a statement of principles the American College of Physicians adopted at its April annual meeting.

The ACP also set out a comprehensive appeals procedure and said doctors should be allowed to append comments to any public ratings reports they believe are inaccurate.

"We're very supportive of quality measurement. But those measures have to be validated and fairly applied," said ACP President David Dale, MD.

The academy said payers clearly should explain the evidence base and analytical methodology used in quality measurement. Internists want payers to allow doctors to challenge ratings on the grounds of validity, reliability, appropriateness, applicability, sample size and confounding factors. The ACP statement also says payers should allow a secondary review by an external board and set up a central source for collecting and analyzing physician appeals.

America's Health Insurance Plans spokeswoman Susan Pisano said it is "standard practice" for insurers to give doctors a first look at ratings and make comments before they go public.

A 2005 survey of pay-for-performance programs by physician ratings software firm Med-Vantage found that 77% had an appeals process in place. But, the ACP statement said, little is known about how these appeals procedures function in practice.