Docs: Ranking System Needs Some Major Surgery Stat | Mass. Med. Society sues state over measures of doctor quality, costs
For nearly 300,000 government employees and family members insured through the state's Group Insurance Commission, the copay shelled out at each doctor's appointment depends on where their physicians fall on an index of quality and cost.
But the Massachusetts Medical Society claims that the rating system is fundamentally flawed, and, together with five physicians, it is suing the GIC and two of the insurance companies that cover its members, seeking major changes or the elimination of the ranking system.
Results Driven
Worcester ophthalmologist Peter Zacharia was placed in the system's lowest tier for the Tufts Health Plan. But the MMS complaint argues he was penalized because he specializes in treating glaucoma, which frequently requires expensive tests.
The complaint also alleges that the rating for Dr. Joseph Adolph of Marlborough, who is in Tuft's middle tier, was hurt by a single case where an expensive radiotherapy treatment was incorrectly categorized as part of his office visit expenses. ]
Both doctors declined to discuss the suit.
Dolores Mitchell, executive director of the GIC, said she wasn't familiar with the specific cases discussed in the complaint, but she said there are bound to be some problems in the ratings.
âBecause this is something that has not been tried on this scale before, are there going to be some misattributions?â she said. âYes. We have always acknowledged that this is a work in progress.â
But Mitchell said moving forward with the rating system is the only way to discover and correct any possible problems.
She said the health plans that insure GIC members correct mistakes when doctors point them out.
And even when there are errors, she said, it doesn't necessarily mean doctors get put into the wrong tier since the rankings are based on a large volume of data collected over three years.
Mitchell said some of the complaints doctors make about their ratings actually point to practices that make the costs of health care less transparent than they should be.
For example, she said, in many practices, all prescriptions are filed under the name of the first doctor listed on the letterhead.
Those doctors may complain that the prescribing records attributed to them are inaccurate. But she said the failure to attribute prescriptions to a particular doctor makes accountability for costs difficult, so practices may want to change their policies.
Mitchell said part of the point of the rating system is to make doctors more aware of excess costs, such as the difference in fees from one lab to another.
âYou've got to be part of the solution, and that means being a little more sensitized to what those cost variations are,â she said.
Frank Fortin, a spokesman for MMS, said his organization supports the idea of using ratings to improve medical care, but it sees fundamental flaws in the way the GIC is going about it.
Modern medicine is a âteam sport,â he said, and ranking doctors individually based on the costs and outcomes of their patients' treatments doesn't make sense.
âIt's not a reliable measure of quality or cost,â he said.
Cost Controls
Fortin points to a study by doctors from the Rochester Individual Practice Association in New York published in the health policy journal Health Affairs last month that criticizes individual ranking systems.
The paper suggests that a better way to control costs is to identify particular drugs and procedures that are unnecessarily expensive and work to shift physicians' treatment patterns to more cost-efficient methods.
Despite their differences in opinion, the GIC and MMS worked together for several years on the ranking system before the current fight broke out.
Mitchell said the commission sought the medical society's comments before it launched the ranking system in 2003 and has implemented some of its suggestions as it rolled out more aspects of the system and added more medical specialties.
But Fortin said the differences between the organizations have become so great that MMS felt it had no choice but to sue. For one thing, he said, the GIC now won't even consider changing the policy of ranking doctors individually.
The latest expansion of the system to include more physicians has also resulted in more of an outcry among MMS members than previous stages, he said.
To make matters worse, he added, the newest version of the system has three tiers rather than two, and the GIC requires insurers to divide their doctors, with about 20 percent in the top group, 65 percent in the middle and 15 percent on the bottom.
âThey forced a curve on the results no matter how well or poorly physicians do,â Fortin said.
Fortin said the system is unfair not only to doctors, but also to their patients, who may have to pay as much as $20 extra for each doctor's visit if their doctor ranks in the bottom rather than the top tier.
To Mitchell, though, the point of the program is to protect patients by helping them find the best physician, and to shine a light on how medicine is practiced and how it can be made more efficient.
Given the constantly accelerating costs of health care, she said, it's crucial to take action instead of waiting for a perfect system.
âYou've got to think about what we are trying to do here,â she said.
Whatever the effects of the rating program, they are likely to be magnified soon. Harvard Pilgrim Health Care, one of the insurers in the GIC system, recently said it may expand its use of rankings to customers outside the state system.
The number of GIC members is also growing. Municipalities and local school districts can now use the state system for their employees.
Mitchell said 12 have already done so and more are expected to join in October.
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