Coping with rankings: Still time for challenges

More health plans are rating physicians, but patients aren't keeping score. Doctors still have time to pressure insurers for accurate data or none at all.

By Jonathan G. Bethely, AMNews staff. June 18, 2007.

Whether physicians like them or not -- and generally, the answer is not -- efforts by health plans, private companies and others to rate doctors based on quality are not likely to go away.

And efforts to make bottom-line decisions based on those ratings appear to be here to stay, too, as some insurers use ratings in part to decide whether a physician is allowed into a "preferred" network, or as the basis for a pay-for-performance plan.

In the eyes of many physicians, ratings often are based on inaccurate or unreliable information, such as data pulled straight from claims. They see the scores as being based on criteria that appear to be focused more on saving money than treating patients. So what are physicians supposed to do when they see themselves rated, and the information is opened to the public? Ratings have been "one of the most gut-wrenching issues for our members since tort reform," said Teresa Devine, director of health care financing for the Texas Medical Assn.

Some physicians and experts say the first thing to do is to take a deep breath and realize there is time to challenge rankings and otherwise deal with them before patients trust them. Most surveys show that very few patients -- often, fewer than 1% -- choose a doctor based on outside ratings.

"The strongest line to physician choice is the relationship," said David Knowlton, president of the New Jersey Healthcare Quality Institute, a coalition of businesses, unions, health plans, and hospital and physician organizations, including the Medical Society of New Jersey. "So that's the strongest tie, and that's good news to doctors because it gives them time."