AMCNO Provides Proponent Testimony on HB 122 – Physician Ranking Legislation

On June 24th, Dr. John Bastulli, Vice President of Legislative Affairs of the AMCNO, provided testimony on behalf of the AMCNO to the House Health Committee on HB 122. HB 122 is sponsored by Rep. Barbara Boyd, and Senator Tom Patton has introduced a companion bill in the Ohio Senate. Both bills were spearheaded through the efforts of the AMCNO and we strongly support the legislation.

The AMCNO testimony keyed in on several important points. Dr. Bastulli noted that the concept of physician ranking and data systems to help ensure greater transparency must be done in a way to ensure that the results are accurate and verifiable. He also stated that physician rankings should be based on quality or quality and cost, but never on cost alone, noting that the way rankings are designed and a process to appeal incorrect rankings should be provided to physicians. In addition he noted that the limitations of physician profiling programs should be provided to patients. 

This legislation would prevent health insurance companies from ranking physicians based solely on specific criteria to persuade a consumer to choose one physician over another. Under this legislation, the designations would be made based on cost efficiency, quality of care or clinical experience and it would establish standards for the physician designations. If passed, Ohio will be on the forefront of implementing important new policy that promotes accurate, safe and effective health care transparency for everyone. 

He informed the committee that insurers have supported obtaining data in order to tier and quantify cost effective care, and consumers have wanted data to compare quality of doctors. The crux of the debate is balancing the rights of physicians to have accurate and relevant reporting of their practice with the desire of health insurers and consumers to have access to information about their treating physician. 

He further stated that many insurers “profile” or “rank” their physicians to analyze and monitor cost of care. The way that insurers do this is calculated through insurer claim databases and analytic software. These systems analyze the actual cost of care incurred by physicians in caring for patients and compare it to the expected and average cost of care. In effect, the insurance company determines its own definitions of “efficiency” based on the difference between expected cost of care and actual cost of care. However, the manner in which insurers define “efficiency” is contentious and requires a better definition. Rather than focusing on the cost of clinical resources for a set of services, there should be greater focus on the overall benefits of care provided, including clinical outcomes. 

The AMCNO testimony expressed concern that doctor rankings can be confusing and could be used to steer patients to the least-expensive health care providers, rather than being based on quality. It is important that the insurance companies are truly reviewing quality issues versus cost and claims data, and the data must be accurate with the ability of physicians to appeal their data.

This legislation stresses that health plans must use risk-adjusted data, and base grades and ratings at least in part on nationally recognized quality of care measures and not on cost alone. The legislation also provides physicians with the right to review and appeal their ratings prior to the ratings being released to the public. The AMCNO noted that we also believe that an independent ratings examiner, with expertise in efficiency measurement should be considered to oversee compliance ranking systems. Additional information on the AMCNO testimony will be in the upcoming issue of the Northern Ohio Physician magazine.