Massachusetts society evaluates health plans' doctor-rating programs

Its report is the latest effort by physicians to analyze how health insurers are analyzing them.

By Emily Berry, AMNews staff. Feb. 11, 2008.

With health plans increasingly issuing ratings of physicians by cost and quality of care, some physician organizations are turning the tables and issuing their own ratings of insurers.

The latest to do so is the Massachusetts Medical Society, which in January released a report detailing how the state's health plans are aligning with its principles on physician tiering, pay-for-performance and prior-authorization programs.

"If data are good, if reporting is good, shining a bright light on operations is good, then certainly the plans are not beyond criticism," said MMS president and Shrewsbury, Mass., ob-gyn B. Dale Magee, MD.

The report's authors found that plans were at least partially meeting the society's guidelines for pay-for-performance, tiering and prior-authorization programs.

The authors included a series of recommendations, including that the health plans adopt a formal appeals process for physicians who are ranked in tiering programs, that they move from prior-authorization programs to prior-notification programs, and that performance measurement be limited to groups until more reliable data are available to measure individual physicians' work.

Dr. Magee said the health plans have, for the most part, been receptive to the report.

Marylou Buyse, MD, president and chief executive of the Massachusetts Assn. of Health Plans, said the group always welcomes physician feedback. But she said she didn't agree with every conclusion in the report.