Physicians Raise Concern about Insurance Company Performance Data

As reported in our last email blast, the AMCNO has been following several pay for performance programs as they are rolled out in our community. Recently the Washington Post reported that physicians who have been rated on quality care and cost efficiency standards say data used to create the ratings often are incorrect and physicians often have no way to correct them. Under the programs, physicians are rated using billing data, health records and software systems. The data sometimes are posted online for consumers' use. While the programs and systems vary, physicians who perform well are usually added to a list of preferred providers. Physicians who have low rankings can be removed from the network or their patients can be charged higher copayments. Some critics maintain that the effort is more about cutting costs than improving quality and enables physicians to "cherry pick" healthier patients whose problems cost less to treat. Proponents say the data encourage patients to use physicians that provide adequate and effective care at reasonable prices, while giving incentives to physicians to improve care.