When it comes to sizing up physicians as low-cost or high-cost providers, health insurers are frequently not on the money, according to a study appearing in the March 18 issue of the New England Journal of Medicine.
By applying current 2-tiered methods of cost-profiling to claims data from 4 Massachusetts insurers, the RAND Corporation, producers of the study, estimated that 22% of physicians would be misclassified. The RAND data showed that the misclassification rate for vascular surgeons in their sample, for example, was 36%. Only 41% of physician cost-profile scores were at least 70% reliable - a common statistical threshold of reliability - and only 9% of profile scores were at least 90% reliable.
Health insurers analyze the costs of an individual physician's services - including the medications, tests, and consults he or she orders - to help them decide who should belong to their provider networks, as well as create tiers within those networks. Patients often are given financial incentives such as lower copays if they choose top-tier physicians who supposedly render high-quality, low-cost services.
The authors of the RAND study wrote that their findings "bring into question both the utility of cost-profiling tools for high-stakes uses, such as tiered health plan products, and the likelihood that their use will reduce health care spending."
"Consumers, physicians, and purchasers are all at risk of being misled by the results produced by these tools," they added.
Organized medicine has long contested the accuracy of physician cost-profiling, and the RAND study prompted the American Medical Association
(AMA) to say essentially, "I told you so."
(AMA) to say essentially, "I told you so.""Inaccurate information can erode patient confidence and trust in caring physicians, and disrupt patients' longstanding relationships with physicians who have cared for them for years," AMA President J. James Rohack, MD, said today in a press release. "The AMA calls on the health insurance industry to abandon flawed physician evaluation and ranking programs, and join with the AMA to create constructive programs that produce meaningful data for increasing the quality and efficiency of health care."
America's Health Insurance Plans, a trade association for health insurers, did not respond to requests from Medscape Medical News to comment on the RAND Study.
The study noted that researchers received financial support from the AMA, the Massachusetts Medical Society, and the Physicians Advocacy Institute in addition to the US Department of Labor, the National Institutes of Health, the Robert Wood Johnson Foundation, and the Commonwealth Fund.
From Medscape Internal Medicine and N Engl J Med. 2010;362:1014-1021
.
.Reviewed / Posted by: Scott W Yates, MD, MBA, MS, FACP
