MMS Adopts Principles for Physician-ranking Programs

WALTHAM, Mass. — Physicians of the Mass. Medical Society have approved a sweeping set of principles for physician ratings, and urged health plans to incorporate them into their ranking programs, while at the same time recognizing the need for physicians to address cost in health care and work harder toward a solution.

The principles were approved by the MMS House of Delegates at its interim meeting in Waltham on Nov. 3 and were developed in response to the Mass. Group Insurance Commission’s (GIC) Clinical Performance Improvement initiative, which ranks individual physicians on various cost and quality measures.

The principles closely mirror the agreement that New York Attorney General Andrew Cuomo announced recently with CIGNA HealthCare. That agreement states, “because measuring physician performance is relatively new, complex, and rapidly evolving, the need for transparency, accuracy, and oversight in the process is great … consumers are entitled to receive reliable and accurate information.”

Dr. B. Dale Magee, president of the Mass. Medical Society, said physicians are concerned that the current rating system provides potentially deceptive and unreliable information to patients. “This encourages a disruption to existing patient-physician relationships and can result in patients paying more for their health care.

“Controlling cost in health care is everybody’s problem, and physicians need to work hard to assure that issues surrounding costs are addressed in a manner that assures quality and guards against unintended consequences,” Magee added. “Ultimately, the best solutions will come through collaboration. For health care to achieve its potential for quality and efficiency, data needs to be shared between the plans and the physicians so that they can use it to better a patient’s care. The current experiments in rating physicians are a distraction from the best uses for this data. Ratings, if they are to be accurate and have value, will be the byproduct of the alignment of physicians and plans and will reflect how well payers and physicians work together.”

The principles adopted by the MMS House of Delegates declare that ranking programs should:

• Aim to strengthen patient-physician relationships;
•  Involve physicians in the design and implementation of all programs;
• Use clinically important and sound performance measures;
• Ensure sample sizes adequate to support meaningful data analysis;
• Rely on meaningful data and analytic techniques;
• Share and review data with physicians or practices prior to public release;
• Ensure transparency of all quality and cost-effectiveness measures;
• Identify and consider practice characteristics that may require special attention in quality and cost-effectiveness monitoring;
• Use uniform reporting formats;
• Minimize unintended harmful consequences; and
• Be pre-tested before implementation.