Insurers expand use of doctor rankings

By Jeffrey Krasner
http://www.boston.com

Health plans that rate doctors individually are spreading beyond the state’s Group Insurance Commission, despite the Massachusetts Medical Society’s opposition to the ranking systems.

Tufts Health Plan, the third-largest health insurer in Massachusetts, says it will expand its health plan that features doctor rankings, called Navigator. And Harvard Pilgrim Health Care, the second-largest insurer, says it is considering offering health plans with doctor rankings later this year to consumers who are not covered through the Group Insurance Commission, which negotiates health insurance for about 295,000 municipal and state employees and their families.

Under such ranking systems, patients who see top-rated doctors often have lower copayments. Insurers say that creates an incentive for patients to seek high quality care at a lower cost. But last month, the Massachusetts Medical Society filed a lawsuit claiming the Group Insurance Commission’s ranking, or tiering, defames doctors who score poorly but actually provide high quality, low-cost care. The suit also alleges tiering defrauds patients who have to pay higher out-of-pocket costs.

The society, which represents about 20,000 doctors, asks for broad changes to the commission’s tiering design. Fail ing that, it wants a Suffolk Superior Court judge to stop the plans from being used.

James Roosevelt Jr., chief executive of Tufts Health Plan, said he is moving ahead with plans to expand the use of rankings because the medical society did not seek an immediate court order to halt Navigator. “This is a product that holds down prices,” he said.

Tufts will add more specialists to its tiering system, including physicians who concentrate in cardiology, dermatology, endocrinology, gastroenterology, general surgery, neurology, obstetrics, ophthalmology, orthopedics, ear nose and throat, rheumatology, and urology.

It is also moving from two tiers to three. Members will be responsible for copayments of $15, $25, or $35, depending on a doctor’s ranking.

Sharon Torgerson, a spokeswoman for Harvard Pilgrim, said it is considering expanding its ranking plan – called Independence – to people who do not receive their health coverage through the commission. The plan now covers about 45,000 Group Insurance Commission members and their families.

“We’re digesting recent events, such as the lawsuit, and evaluating the level of customer demand for this,” said Torgerson.

The Group Insurance Commission has long been an innovator in healthcare plan design. It was among the first to introduce tiered pricing for medications, in which patients pay less for generics. It started ranking physicians two years ago.

Dolores L. Mitchell, longtime executive director of the commission, said tiered physician groups have allowed her to keep average premium increases that go into effect July 1 to 5.6 percent. Most commercial health plans have raised rates between 8 and 12 percent for each of the last seven years.

Still, she said, the commission has not completed a study that will show whether doctor rankings have helped contain costs.

The medical society wants the experiment shut down until such proof is available.

“There’s no doubt that a lot of insurers are looking to experiment with physician rankings in the hope they would have an impact on cost,” said Frank Fortin, a medical society spokesman. “But at the GIC, there’s no structure in place to track the cost savings, so you don’t know if it’s harmful or if it has a negative impact on access to care or quality. It’s unscientific.”

The lawsuit names the Group Insurance Commission, Mitchell, Tufts Health Plan, and UniCare Life and Health Insurance Co. as defendants. They have until July 2 to respond to the complaint.

Separately, the medical society said it received 17 boxes of documents from the commission, responding to a wide-ranging request under the Freedom of Information Act. The society hopes the documents, which examine all aspects of the move to tiered physician rankings, will help substantiate its complaint.

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Copyright 2008 Globe Newspaper Company

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