Opinion: Mass. Doctors: Ranking Systems Need To Go
By Dr. B. Dale Magee
New York's Attorney General Andrew Cuomo recently attempted to hault tiering programs by some insurers in the Empire State. He advised, "When making health care decisions, it is vital consumers have as much honest information and unfiltered advice as possible. Ranking systems are in their infancy. Consumers should use caution and have an open dialogue with their doctors."
Physicians in Massachusetts heartily agree with Attorney General Cuomo. In Mass-achusetts, it is a state agency - the Group Insurance Commission (GIC) - that is currently using this approach to health insurance coverage.
In an attempt to address this issue, the GIC has initiated a tiering program dubbed the "Clinical Improvement Initiative" that asks patients to pay more to see doctors that are labeled as less efficient or of lower quality. It is an unproven technique.
Flawed System
Imagine someone rating your fitness to be a parent based on your credit card bills from a few years ago. The system being used for tiering is actually less accurate than that, since the doctors being rated do not even get to confirm that the bills being used are not in error. Physicians requesting the data (only made available after they have been rated) have been subjected to months-long delays and have been given informtion that is sketchy at best. Even so, significant errors have been found, raising questions about the reliability of the data.
To its credit, the GIC has put together a physician advisory committee to provide advice on improving the program. As a result of this, plus numerous recommendations provided by the Massachusetts Medical Society, the GIC has changed some of its measures and insisted that the plans provide doctors with a uniform report to explain their ratings. But this is still not enough information to allow physicians to see rational opportunities to modify their care plans for patients or to correct errors in the information being used to rate them.
There's no doubt that vigorous efforts are needed to try to rationally control the costs of health care. This is an issue that all of us - patients, physicians, managed care companies and other providers of care - should make our own. To date, too little has been done, and costs are reaching levels where municipalities are being forced to cut back on basic services. Street lights are being turned out at night, libraries are being closed, and school committees are trimming curricula while health insurance premiums consume an increasing portion of budgets.
Physicians, hospitals and managed care companies need to find ways to work together to address the cost issue without compromising care. This will only come when information is available to doctors at a time and in a manner that will allow them to make choices when prescribing care. While well intentioned, there are only two words to describe the current tiering system for health insurance: caveat emptor. New York State Attorney General Cuomo is right.
Dr. B. Dale Magee is president of the Massachusetts Medical Society and a practicing gynecologist in Shrewsbury.
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