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AIS's Health Business Daily
Featured Story June 24, 2009 Is Qforma/USA Today Web Site on 'Most Influential Doctors' Just Another Beauty Contest? Reprinted from INSIDE CONSUMER-DIRECTED CARE, a newsletter with timely news and insightful analysis of benefit design, contracts, market strategies and financial results. By Michael E. Carbine, Managing Editor, (mcarbine@aispub.com) When Qforma and USA TODAY announced the launch of Most Influential Doctors (MID) last month, Qforma CEO Kelly Myers said in a Webinar media briefing that the new service would be a helpful tool for consumers to use in locating local physicians who are considered by their peers to be leaders in their fields. But some critics have pointed to shortcomings in the methodology used to identify these physicians, and many question its ultimate value for consumers. "This kind of site is based on [information from] a better panel of judges than your friends and colleagues," Francois de Brantes, CEO of Bridges to Excellence (BTE), tells ICDC. "But it's a beauty contest because it's reputational and superficial." de Brantes says that the information used by MID and other physician rating services may be of some value when consumers search for a physician, and they certainly are grounded in more reliable information than that used by friends and colleagues. "But there is no substitute for empirical clinical data." He also contends that we might have a better chance at getting consumers to seek out and use clinical quality data when selecting providers if health plans would stop blending cost with their quality data and utilize differential copays for member physician and hospital use based on a provider's clinical quality rankings. BTE is a nonprofit coalition of large employers, health plans and providers that identifies and then provides financial rewards to physicians who are delivering higher-quality, evidence-based care. The ratings are based on data obtained from the physicians' actual medical records. BTE works with the National Committee for Quality Assurance (NCQA); MN Community Measurement, a Minnesota clinical quality measurement collaboration; and IPRO, an independent, nonprofit quality improvement organization, to create the performance assessments. MID uses referral network rankings, practice patterns, publication history and leadership positions in professional associations to identify who Qforma says are the top physicians that other physicians in that local area turn to for treatment advice and opinions. The initial MID launch, accessed on the USA TODAY Web site, includes physicians in every metropolitan area but only in four disease categories: diabetes, high blood pressure, high cholesterol and asthma. Myers says that four new disease categories will be added every quarter during the coming year. Next on the list: breast cancer, chronic obstructive pulmonary disease, depression and osteoarthritis. Kelly stressed that the listing encompasses only physicians who are considered to be regional leaders by their peers. Criteria used to make this determination include referral network rankings, publication history and leadership positions in professional associations. Because Qforma provides prescription data analysis services to the pharmaceutical industry, physician prescribing patterns also are included in the criteria. But because these patterns are obtained from prescription drug databases, physicians in states like New Hampshire that prohibit the commercial use of prescription data are not included in the MID listing. And a question submitted by ICDC about how a physician's prescribing records relate to quality was not answered. The analysis also does not factor in patient outcomes. BTE Uses Medical Record Data Currently, somewhere between 40 and 50 Web sites and other groups rate physicians. While a small but growing number use claims-based clinical data to compare physician groups in terms of how they treat health conditions, most are based on consumer ratings or information concerning a physician's education, disciplinary actions, board certification, experience and customer service. BTE, on the other hand, analyzes medical records to measure physician performance. The organization then compiles a list of high-quality, top-performing physicians based on their care for patients with chronic diseases ranging from diabetes to coronary artery disease. While BTE doesn't offer consumers a Web site where they can search for top-performing physicians, HealthGrades, a national provider ranking site, has access to BTE's results and identifies these physicians on the free-access part of its site. de Brantes says about a dozen community-based organizations across the U.S., including the Cleveland Health Collaborative, post BTE results for consumer viewing. MN Community Measurement also offers consumers a physician rating Web site as well as a special site that ranks physicians based on the quality of care they deliver for diabetes (www.thed5.org). He notes that BTE "is working everywhere in the country to help organizations launch similar initiatives." To date, BTE has identified 20,000 high-performing physicians, and the number is growing. But while several major health plan operators, including CIGNA Corp., UnitedHealthcare and Aetna Inc. are using BTE's quality data, de Brantes worries that consumers see only the cost data that are blended into the information insurers provide, and assume that their health plans are steering them to the less expensive physicians. "One of my big pushbacks on this issue is that we tend to use blended rankings that use some measures of cost and quality," he says. "But the average consumer ignores the quality part, assuming that cost is the biggest factor used by the health plan." This isn't true, he admits, but it's what most consumers believe. His solution: Health plans should focus "laser-like" on the quality issue to rebuild consumer trust in the ratings. He also argues that consumers would use the quality data if they had differential copays depending upon which hospitals and physicians they used, with the differential based on objective assessments of quality rather than cost. "We need to change the perception that health plans are steering patients to the cheapest doctors," de Brantes says. "And we can do this by getting out of the business of blending cost and quality and focus just on quality. Once we've restored consumer confidence and trust, then we have a shot at people using the data." Visit the
Qforma/USA Today Most Influential Doctors Web site at www.usatoday.com/news/health/qforma-most-influential-doctors.htm.
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