The American Medical Association has called into question the way in which health plans profile doctors, for the purposes of identifying doctors who profile favorably by the measurements the plan uses.

Key points in this story:

• Rand Corporation studies show that these ratings can be wrong as much as 66% of the time.
• The same studies also show that physicians’ specialties can be misclassified as much as 25% of the time, using the “best case” scenario.
• Patients, the AMA concludes, are being encouraged or rewarded for using doctors who profile favorably, consistent with the health plan’s assessments even though these are based on data which is being questioned.
• The AMA asserts that the methods used are flawed.

Medpage Today

…“While we understand and support health insurer and payers’ desires to provide the public with information on high quality and efficient healthcare, the AMA and the Federation of Medicine cannot support payer programs designed to steer patients to certain physicians and practices based on inaccurate physician ratings or primarily on physician cost of care profiles without regard to the quality of the services provided,” the letter continued.

“The association cited a series of recent RAND Corporation studies which found that “physician ratings, based on cost of care, can be incorrect up to two-thirds of the time for some physician specialties while misclassifying one-fourth of all physicians under the best-case scenario used by most health insurers.”

…”As a result of these profiling efforts, “patients are being encouraged, and often incentivized, to leave longstanding relationships with physicians they trust, or see certain physicians and physician groups, based on information that RAND has shown to be incorrect 25% or more of the time,” the letter continued.

“In some cases, the AMA said, “Physicians’ reputations are being unfairly tarnished using unscientific methodologies and calculations. Some physicians have even been placed in three different efficiency tiers by three different insurers based on calculations using the same data.”

Source: Medpage Today,July 20, 2010