Doctor Ratings Revised


Several health-insurance companies have recently agreed to improve their existing or planned ratings of physicians.

But consumers shouldn’t rely on such reports alone when picking a doctor. Also consider personal referrals and a doctor’s experience and education.

Ratings by some insurers have come under fire for giving top scores to doctors who cost the least — but who are not necessarily the best in quality or the ones handling the most complex cases. In some plans, there are financial incentives for members to pick high-scoring doctors for their care.

Over the next year, the rankings will become more transparent and thorough under agreements reached in recent months between several of the biggest health insurers and New York Attorney General Andrew Cuomo. Aetna, Cigna, UnitedHealthcare and WellPoint have said they’ll apply the agreed-upon approach to their ratings nationwide.

The insurers have agreed to rate quality as well as cost and to use independently accepted criteria — which might include, for example, measures from the not-for-profit National Committee for Quality Assurance — instead of just claims data to rate physicians. They also will adjust for risk so that, for example, a doctor is not penalized for handling more complex cases that may result in higher costs and more deaths.

Additionally, doctors will be able to review the data and appeal the decisions.

‘Major Step’

“The ratings have not been accurate,” says Nancy Nielsen, president-elect of the American Medical Association. “This is a major step in transparency.”

Susan Millerick, a spokeswoman for Aetna, says information being added to that company’s Aexcel rating program in early 2008 should “give the consumer more confidence in the ratings.” She adds: “We want our members to be as informed as they can be, and as confident as they can be, before they go to the doctor.”

Besides data on costs, the insurers’ ratings may include information on doctors’ education and on whether they follow standards consistent with professional associations such as the American Heart Association or the American College of Obstetricians and Gynecologists.

Ask Around

But “at the end of the day most of us rely on friends, family and word of mouth” to choose a doctor, says Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change, a research group in Washington. She recommends asking a trusted pediatrician, internist or family physician for a referral to a specialist. If you don’t have a doctor, ask friends and family for recommendations.

Hospital nurses also are a great resource. “They know who is nice, and they know who is good,” says Dr. Nielsen of the AMA.

Ms. Cassil recommends that consumers look for doctors who are board certified. She also suggests checking with state agencies, many of which have online records, for any disciplinary actions.

The AMA’s Web site includes a DoctorFinder with basic information on physicians.

Once you’ve identified a doctor, don’t be afraid to ask questions. For instance, consumers are entitled to know how often a doctor performs a procedure.
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