Programs that rate doctors face challenges

Health insurers attempting to implement programs rating doctors on cost and quality have run into disputes with several health care provider organizations.

UnitedHealth Group Inc. canceled the launch of a "Premium Designation" pilot program in Missouri in 2005 when it sparked furor in the medical provider community.

Physicians objected to the plan to implement a rating system for physicians in St. Charles County because the program was based on price rather than quality, said Dr. Stephen Slocum, an ophthalmologist and president of the St. Louis Metropolitan Medical Society. Ratings were developed for specialties such as ophthalmology that do not have recognized quality standards and were based solely on pricing consideration, he said. "They were telling people it was a quality plan when it was really a cost plan," Dr. Slocum said.

In its letter to a UnitedHealth unit seeking to halt the program's New York launch, the state's Attorney General's office specifically referred to the Missouri situation, but a UnitedHealth spokesman said the program has been revamped since then with input from various medical groups.

Any remaining concerns about the insurer's rating program are fundamental objections to pricing transparency, the spokesman said. "There's still some in different camps refusing to acknowledge that this is where the marketplace is going," the spokesman said.

Blue Cross Blue Shield of Texas had a similar dispute with physicians when the insurer announced in December 2006 it would rate providers in Texas based on quality and affordability. "It was basically just an evaluation based on claims data," said Dr. Bill Hinchey, a pathologist and president of the Texas Medical Assn. in Austin. "No evaluation on the quality of the work. No evaluation on the outcomes. And the doctors were furious."

In response to physician demands, the Richardson, Texas-based insurer agreed to delay the launch of the program and has been working cooperatively with a physician advisory committee created by the TMA to address the issues raised by the physicians, Dr. Hinchey said.

BCBS of Texas launched a revised rating system in May that eliminated some of the complicated metrics the doctors objected to and developed a procedure for individual doctors to provide feedback, a spokeswoman for the insurer said.