Doctors Urge Insurer to Delay Release of Flawed Physician Rating Program

MINNEAPOLIS, Jan. 18, 2011 /PRNewswire-USNewswire/ -- The Minnesota Medical Association has asked Medica to delay the January 19 scheduled public release date of their individual physician rating program, known as the Premium Designation Program.

The MMA has found three significant problems – its lack of reliability testing, lack of Minnesota physician involvement in its development, and a woefully inadequate timeline for physicians to review their results and underlying data.

"We have serious concerns that this program will provide patients with unreliable and misleading information about the cost and quality of care being provided by Minnesota physicians," said MMA President Patricia Lindholm, M.D.

Here are some errors that physicians have found in the data:

• Medica penalized one physician for failing to order a Pap test, when in fact the patient had a total hysterectomy nine years ago.  
• Medica faulted a physician saying the patient should not have received nonsteroidal anti-inflammatory drugs because the patient had hypertension, when in fact the patient's blood pressure had been normal for years.
• Medica penalized a physician for failing to do a strep test when the test in fact was done.

"Errors such as these and others including errors in specialty designation and inclusions of retired physicians demonstrate that this program is not ready for prime time," Lindholm said. "Releasing inaccurate information about individual doctors will harm reputations and mislead patients looking for help finding quality care."

The MMA is a supporter of  performance measurement of doctors and clinics when such analyses are valid, reliable, and useful. But this is the first time rating of individual doctors has been tried in Minnesota and this program is inconsistent with Minnesota's community standards of measuring clinic performance.

A review of a similar physician rating program in Massachusetts found that 22 percent of the physicians were likely to be misclassified.  The RAND researchers concluded, in the March 18, 2010, issue of the New England Journal of Medicine, that current methods for assessing physician performance may produce misleading results.

The Medica Premium Designation Program is a United Healthcare-developed program. Physician results will be publicly presented using 0-2 stars, with two stars used if a physician meets the quality and cost efficiency criteria, one star used if a physician meets only the quality criteria and no stars if the physician fails to meet the quality criteria.

SOURCE Minnesota Medical Association