Thursday, December 07, 2006

When Insurers Rate Doctors

Beginning in January 2007, Blue Cross Blue Shield of Texas will post online indicators for Texas physicians regarding "guideline performance" and "affordability" called "BlueCompare":
BlueCompare is a program developed by Blue Cross and Blue Shield of Texas to enable more informed health care decisions by consumers.
Oh, but don't worry:
This information is provided to assist you in selecting a health care provider. It is not intended to be a recommendation. (emphasis mine - wait, are you "assisting" or "recommending?") Your selection is a personal choice, and you should not base your decision solely on Affordability or Evidence Based Medicine (EBM) Indicators.
Not a recommendation? Oh, pleeeeze! What else do you call it? A suggestion?

Worst of all Blue Cross offers no mechanism to determine if their "EBM's" are accurate, nor are they verifiable. Where do these data come from? Most insurer personnel I know don't have a CLUE about medicine. Yesterday, I spent over an hour on the phone trying to get a test paid for by XYZ insurer because the screening personnel didn't know the difference between a vein and an artery. Bozos all.

And how often will these "website doctor thingamabobs" be updated? If I were a doctor in Texas (and no doubt this trend will spread), I would want to know the methodology and update frequency of this site. We doctors recognize that these indicators/suggestions/recommendations have NOTHING to do with the care provided by doctors (although they sure imply it), rather they only measure the documentation of the care provided.

But why should anyone care?

Because to not understand methodologies and verifiabity of this data subjects Blue Cross to potential charges of slander against doctors in whom data are misrepresented. And even worse, when a patient with chest pain goes across town in Houston to see a "more affordable" doctor and dies en route due to delayed therapy, there might just be hell to pay.

-Wes

1 comment:

Rob said...

We follow our own quality numbers (especially in diabetes). I got a quality report from an insurance company (begins with "United" and ends with "Healthcare") assessing my quality numbers. I analyzed the numbers and found that they were a 50% underestimate of my quality. So I sent them a letter assessing the quality of their quality report. I said: "I am very disappointed with the quality of your quality report. There is a greater chance that your information is incorrect than correct. For this information to be useful, I would appreciate you working on this problem."

It was fun to do - I got a form letter in return. We need to be advocates of our own quality and pushing the numbers ourselves. If we don't, then the best info available will be that of the dark side (beginning with "Insurance" and ending in (Companies").

Rob