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    Physician report cards: Help, ho-hum or horror?

    Public scorecards on individual doctors are just around the corner, and payers want you to supply the data.

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    Up to now, most healthcare "report cards" for consumers have focused on hospitals and large physician groups. That's about to change.

    Two medium-sized health plans and an employer coalition—all in different states—are already publishing web-based scorecards on individual doctors and small practices. Big insurers such as United and Aetna publish very basic rankings, while some Blues plans—including Highmark in Pennsylvania—are preparing more-detailed report cards. And CMS, now soliciting physician quality data on a voluntary basis, wants to post individual report cards as soon as possible.

    Claims data still form the basis of most scorecards. But there's growing pressure on physicians to supply their own data, both to increase accuracy and to expand payers' knowledge of what care is actually being provided. So now you have one more reason to get an EHR: Your public image may depend on it.

    While advocates argue that published ratings will lead to better care, critics warn that they could have the opposite effect. For example, scorecards could motivate physicians to avoid noncompliant patients and to provide some interventions inappropriately in order to reach "target rates," notes internist and economist Rachel M. Werner of the Philadelphia VA Medical Center, who's also an assistant professor at the University of Pennsylvania School of Medicine.


    Power Points
    Should physicians be afraid of public reporting? "If the data are statistically valid and reliable and the scores are an accurate reflection of quality, physicians should have nothing to fear," says Werner. But, she adds, the catch is that we don't know yet whether the measures actually do reflect quality.

    Those quality metrics will improve, predicts Geoffrey B. Baker, CEO of Med-Vantage, a health informatics firm in San Francisco that builds report cards and pay-for-performance programs for insurance companies. Among other things, he predicts, report card makers will design a process that "delivers actionable results to physicians for follow-up on nonadherent patients."

    Baker believes that scorecards comparing individual physicians and other providers can "change American healthcare. This will be the basis on which Americans decide on their care needs as they take on more of the financial responsibility for their own health."

    Whether or not that's true, it's clear that public ratings are in your future. Here are the experiences of some physicians with the first generation of report cards.

    Doctors accept scorecards, but with reservations

    So far, there has been little physician resistance to report cards. For instance, the Geisinger Health Plan, based in Danville, PA, posted its first report card on the web in late April, and only a handful of the 1,500 primary care physicians in its network chose not to be publicly ranked, says geriatrician Anthony Aquilina, the plan's regional medical director. He adds that the physicians were able to see what their report cards looked like for more than a year before they were published.

    The Geisinger scorecard looks at chronic and preventive care, patient satisfaction, and access. But although it compares practices, rather than individual doctors, most practices in the plan's network have only one or two doctors, says Aquilina. So, to a large extent, this is a report card on individual practitioners.

    The same is true of the report card issued for two and a half years by the Maine Health Management Coalition (MHMC), a group of employers, health plans, and providers that are trying to improve healthcare quality in Maine. In this sparsely populated state, soloists form a large portion of the physician community, so the coalition's report card on practices lists many doctors by name.

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    Ken Terry
    The author is a former senior editor of Medical Economics.

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