Rating System Raises Concerns

Beginning in July, state employees enrolled in Tufts Health Plan will have to pay significantly higher co-payments if they seek care in certain hospitals, as a result of a new health insurance product that Tufts and the state’s Group Insurance Commission announced last week.

The Mass. Hospital Assoc. (MHA) and individual hospitals are concerned that that the Tufts rating system is fair neither to hospitals or consumers. For instance, a hospital that provides specialized care to patients with the most difficult-to-treat ailments could have a record of poor “outcomes,” and, hence, poor ratings from Tufts. However, that “Tier 2” hospital (as rated by Tufts) could be the most appropriate setting for the patient.

“While it would have been preferable to delay release of the hospital information until the fundamental questions and concerns were fully aired and resolved, hospitals will continue to advocate for improvements,” MHA President Ronald Hollander said. “Going forward, what we need from the health plans is collaboration, openness regarding the rating methods employed, and a uniform methodology that will prevent different plans from issuing different scores for the same facility.”

Tufts is planning to make its “Navigator” tiered plan available to all employers on Jan. 1, 2005. Other insurance companies are planning similar rollouts, setting the stage for a series of conflicting hospital “report cards” that penalize patients for choosing facilities they desire.