Some physicians criticize health insurer rating programs based on quality and cost-effectiveness

Health insurers increasingly are rating providers based on quality and cost-effectiveness, but some physicians say that the rating systems rely too heavily on patient claims data and that insurers give favorable ratings to doctors who charge the least amount of money, the AP/Washington Examiner reports.

Insurers say the programs, which sometimes result in lower copayments for patients who visit top-rated doctors, are "an attempt to help employers struggling with ever-rising health care costs to ensure that their money is well spent," according to the AP/Examiner.

Jeffrey Kang, senior vice president and CMO at Cigna, said rating doctors by quality of care and cost-effectiveness can reduce health care costs by 3% to 5%.

Blaine Bos, a partner at Mercer Health & Benefits, said employers have indicated their interest in such programs but are hesitant to use them because there are no universally accepted quality measures.

A Mercer study found that 9% of employers with more than 500 employees last year used programs that ranked physicians by quality.

According to the AP/Examiner, "Many physicians suspect insurers' motivation" for the programs is increased profits, and some have filed lawsuits against insurers using rating systems.

Jim Rohack, a cardiologist and American Medical Association board member, said, "We're concerned that as insurers try to maximize profits, they are saying that the doctor that charges the least amount of money is the highest quality."

Physicians also say that using patient claims data to determine the ratings can be misleading because the data show only what tests or services a patient received but not what a doctor ordered.

Insurers acknowledge that claims data sometimes can be incorrect and say that while using "physicians' medical records would be a better vehicle," it "isn't economically feasible until they are all available electronically, and employers can't afford to wait as health care costs jump," the AP/Examiner reports.

Charles Cutler, chief medical director-national accounts at Aetna, said that insurers need to talk to doctors about why quality rating programs are necessary.

Culter said there is a lack of incentives for physicians to practice cost-effective medicine and doctors might not know the cost of different services (Agovino, AP/Washington Examiner, 2/7).