Ariz. Healthcare Insurers to Have Physician Rating Program

August 5, 2005

Two of Arizona’s largest health insurers are rolling out programs that will rate physicians, and patients could get cheaper co-payments if they choose doctors who receive high marks for both quality of care and cost efficiency.

UnitedHealthcare and Aetna are leaving it up to the employers on how they use the physician-rating service.

Some physicians in the Phoenix metropolitan area say the plan could push patients toward those doctors who don’t perform expensive tests or services.

“It doesn’t mean the patients will be getting the best guy in town,” said Dr. Marc Rosen, a Glendale orthopedic surgeon and president of the Maricopa County Medical Society. “In some cases it will mean the exact opposite.”

Insurers say they are rating doctors because patients usually have little information about the ones they select and how they stack up against their peers.

Giving more information is especially important as more employees enroll in consumer-driven plans, in which they have greater say on where they spend their health care dollars.

“This gives consumers a tool to make their own judgments,” said Dr. Robert Beauchamp, medical director of UnitedHealthcare’s Western region.

The programs are part of a move by insurers and employers to “pay for performance.”

Insurers scrutinize medical claims to find out how doctors in their networks meet certain criteria such as prescribing beta-blockers for heart patients or reducing costly hospital readmissions. In some cases, hospitals also are ranked.

The plans’ rating system is similar to what many employees face in paying for drugs: low-cost generics, middle of the road for brand names and expensive for non-formulary drugs.

The physicians are evaluated on criteria such as whether their patients get mammograms or face costly hospital readmissions.

Doctors worry the rankings won’t help patient care.

“There is a great deal of concern in the physician community,” said Chic Older, executive vice president of the Arizona Medical Association. “As a general rule, physicians are very skeptical about various managed-care plans. For some physicians, pay for performance means pay for less expensive services.”

So far, 25 employers around the country have chosen Aetna’s Aexcel performance plan, affecting about 300,000 workers. Many of them require workers to use Aexcel specialists.

Aetna is talking with several of its existing national clients who may want to use Aexcel in Arizona and its list of doctors will be available by October.

UnitedHealthcare will unveil its physician rankings in January but is asking employers to hold off tying rankings to employee benefits until everyone becomes more familiar with the system.

Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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