Providers are cautiously optimistic that an accord announced last month will lead to more fair and uniform standards on how physicians are ranked by health plans.
It will be a different level of conversation, we hope, says Nancy Nielsen, M.D., president-elect of the American Medical Association, which is supporting the proposal. A lack of transparency has hampered the conversation so far.
The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs, announced April 1, follows recent agreements between New York Attorney General Andrew Cuomo and seven health plans over their physician-ranking programs.
The charter, which was created by the Consumer-Purchaser Disclosure Project asks all health plans to retain, at their own expense, a nationally recognized, independent healthcare quality standards group to review their physician performance programs within three months of signing on, and with the review conducted within six months.
Health plan measures should include both quality and cost information and have a clear process for resolving consumer and physician complaints and appeals, according to the charter. Physicians should provide input into the process, and measures and methodology should be transparent, valid and based on those endorsed by the National Quality Forum.
The patient charter is backed by major consumer and business groups including the AARP, AFL-CIO, National Business Coalition on Health and Leapfrog Group. We do think this is a groundbreaking initiative, says Karen Ignagni, president and chief executive officer of Americas Health Insurance Plans, which is supporting the charter. We anticipate we will have a lot of excitement about this charter across our members.
Of course, the proof is in the details, and physician groups, which generally oppose report cards, say that data-collection methods and other factors need to better reflect the physician-patient relationship.
For instance, small and medium-size practices might have 200 diabetic patients, of whom a small subset of, say, 25 have Aetna as their insurer. Aetna should judge a physicians performance treating diabetics based on aggregate data from all 200 patients, not just the 25 people who carry Aetna, says Douglas Henley, executive vice president of the American Academy of Family Physicians, which also is supporting the charter.
If its done badly, as it has been done in some markets, it causes chaos and confusion among consumers and anger and frustration among physicians, the AMAs Nielsen says.
Among the complaints is that insurers use too-small sample sizes that inaccurately reflect physician performance, and that physicians have no way to appeal the rankings, Nielsen says. Cuomo has concerns that the rankings were based solely on cost instead of quality.
The hospital industry appears to be on the sidelines on this issue. The American Hospital Association has not taken a position on the charter, but the effort is very much in concert with what we are doing with hospital quality measures, says Nancy Foster, the associations vice president of quality and patient safety.
So far, Aetna, Cigna Corp., UnitedHealth Group and WellPoint say they support the patient charter, stressing that the principles reflect their physician-performance programs. Ignagni says she expects many more health plans to sign on, and agreed that there are many details to be worked out.
You have to walk before you can run, she says. Were all going to be involved in data collection.
The National Partnership for Women & Families will be tracking which health plans sign on through its Web site, says Debra Ness, president of the group. Consumers are desperate for information on how to make better healthcare choices, she says.
As part of the New York agreements, health plans are required to have a third party vet their physician-ranking programs, and so far three insurersAetna, Cigna and UnitedHealth Grouphave contracted with the National Committee for Quality Assurance to perform this task. The new patient charter could mean more business for the NCQA.
Cigna, which was the first insurer to strike a settlement with Cuomo on this issue, says its support for the charter signals our continued commitment to having our processes for measuring physician performance validated by outside, independent organizations, said Jeff Kang, M.D., Cignas chief medical officer, in a written statement.
Peter Lee, executive director of national health policy for the Pacific Business Group on Health, says uniform standards will lend legitimacy to health plans physician-ranking programs. We dont want patients to say, This is a bunch of hooey; this is from my health plan, Lee says.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.