More doctor data on the Web

By Jay Greene
http://crainsdetroit.com

In what appears to be a truce between doctors and health insurers nationally over the publishing of physician quality data on the Internet, a number of Southeast Michigan health insurers are expanding their efforts to inform members of higher-performing doctors within their provider networks.

Each health insurer that operates in Southeast Michigan has a slightly different approach to collecting and reporting physician quality data.

But once patients become comfortable with the online rating systems, local insurance executives expect patients to select the higher-quality doctors.

In most cases, executives say, these doctors also provide the least-expensive overall treatments.

The executives believe the eventual shift in market share to higher-performing doctors will encourage more physicians to adopt best clinical practices, which will improve medical outcomes.

For example, Health Alliance Plan in Detroit compares the performance of 15 physician organizations on some 18 preventive services and chronic disease care measures. HAP, which began its quality reporting system in 2003, does not rate individual doctors.

HAP rates physician organizations on heart attack care, immunizations, cancer screenings, diabetes management and antidepressant medication management, said Dr. Bala Pai, HAP’s senior associate medical director.

Priority Health in Farmington Hills lists individual doctor quality measures in disease management, patient satisfaction and preventive health. Priority’s measurements include asthma and diabetes care, the time it takes doctors to return phone calls, breast cancer screening, childhood immunizations and tobacco screening.

While Priority first rolled out its reporting system in western Michigan in 2003, the insurer currently is working with doctors in Southeast Michigan on what quality criteria it will publish. The information is expected to be made public within the next two years, said Kim Suarez, vice president of medical operations.

Blue Cross Blue Shield of Michigan in Detroit does not currently publish quality information on doctors. But the state’s largest insurer has a financial incentive program in which it pays medical groups for meeting quality targets, said Helen Stojic, its media-relations director.

Humana Inc. officials said they now offer physician quality reports in Southeast Michigan.

Aetna last year began offering members quality and cost information on physicians and hospitals through its Web site.

While the Michigan State Medical Society in Lansing does not oppose the physician quality reporting systems, Dr. Michael Sandler, the society’s president, has some reservations.

“Our concern is that it may be difficult for individual physicians to collect and report the quality information,� said Sandler, who also is diagnostic radiologist at Henry Ford Health System in Detroit.

“Larger groups have come together to present aggregate data. They are very concerned that the data provided (to insurers) will accurately represent their practices with appropriate risk adjustments,� Sandler said. “You can have a small number of high-risk cases that skews the numbers.�

Sandler said the medical society believes doctors should be reimbursed with high enough financial incentives to pay for their data collection costs.

“Doctors are reassessing their style of practice, but I don’t believe there has been a sufficient period time to see how well this plays out yet,â€? Sandler said.

Nationally, physician quality rating systems have been met with stiff physician opposition and legal action.

Last November, New York Attorney General Andrew Cuomo and four large health insurance companies, including Aetna Inc., reached a settlement over the plans’ physician quality ranking programs.

Cuomo had accused Aetna, Cigna, Empire BlueCross BlueShield and UnitedHealthcare with a scheme to use quality and cost data to steer patients to the least expensive, but not the highest quality physicians.

The settlement led to a set of principles on collecting and reporting physician data between the health insurers and several large physician associations, including the American Medical Association and the American Academy of Family Physicians.

Unlike New York and other parts of the country where tensions have flared over similar physician quality rating systems, Southeast Michigan insurers appear to have learned valuable lessons in how to work collaboratively with physicians.

Still, some local experts believe the New York settlement may discourage Michigan insurers from expanding their physician quality reporting programs by adding more cost and efficiency measurements.

“A lot of doctors were left with a sour taste from some of the early scoring and rating programs that (national) health plans instituted,� said Mark Kopson, chairman of the health care industry group at Plunkett & Cooney P.C. in Rochester Hills.

At Aetna, higher-performing doctors in 12 specialty categories receive a “blue starâ€? designation on the health plan’s Web site, said Deborah Lantzy-Talpos, Aetna’s Michigan market head in Southfield.

A blue star rating indicates the doctor has met several quality and cost-efficiency measures required to be listed in Aetna’s Aexcel program. Some of the measures include hospital readmission rates after 30 days, complications during hospital stay and cost of services.

Priority Health rates physicians on a system that uses numbers of apples to indicate higher performance. Four apples is a top score with one apple indicating the physician needs improvement. Some 86 percent of physicians who are rated have achieved three-apple status, Priority Health said.

HAP’s physician reporting system gives four stars to physician organizations that score above the 90th percentile of all organizations, three stars for 75th to 90th percentile, two stars for the 50th-75th percentiles and one star for scoring less than the 50th percentile.

HAP rates about 3,000 primary care physicians. After several years of using a physician-to-physician coaching program, Pai said only about 3 percent, or about 100 doctors, are considered low performing.

To boost performance, HAP also provides physicians with decision-support tools, including alerts to physicians when a member requires a preventive service, Pai said. Doctors also have access to patients’ complete health reports, including medications used, hospitalizations and emergency department visits.

Like most of the pay-for-performance incentive plans and quality reporting initiatives, health insurers vary in their approaches.

For example, Aetna’s Aexcel does not offer doctors financial incentives for higher quality, while Blue Cross does not make public its physician quality rating system.

Before Priority Health began publishing quality information on physicians, Suarez said the health plan first implemented a financial incentive program in 1997.

“We paid doctors based on their performance, then reported back the results to them,� Suarez said. “We got them comfortable with program and with measurements.�

In 2007, Priority paid out approximately $7 million to participating doctors, she said. The incentive program is based on generally accepted quality measures that include meeting preventive, quality and patient satisfaction measures.

But Dr. Robert Jackson, a family doctor at 11-member Western Wayne Physicians in Allen Park, said many primary care physicians are at a disadvantage because they must spend large amounts of money to purchase information systems to collect and report the quality data.

“They may give us little rewards, but it is like a stick,� Jackson said. “I have good quality ratings, but the financial incentives are not enough to cover the costs.�

“We are paying two part-time employees to do more financial and quality work now that the insurers have the reporting systems,� Jackson said.

Jay Greene: (313) 446-0325, jgreene@crain.com

see original

About