Wednesday, July 25, 2007

Anybody Know A Good Lawyer?

We're gonna need it. It seems UnitedHealthcare is up to no good again:
In the Washington metropolitan area, UnitedHealthcare has been gathering and evaluating data on physicians and in January rolled out a Web site that ranks physicians with zero, one or two stars. Officials at the District of Columbia Medical Society said they were told that the goal of the Premium Designation program was to encourage physicians to refer patients to two-star doctors and for patients to seek out two-star physicians.

"We were shocked that they would be profiling physicians for the past 18 months and not tell anyone," said Peter Lavine, chairman of the board of the medical society, which met with UnitedHealthcare officials last fall.

Officials with UnitedHealthcare, the nation's second-largest health insurer and a unit of UnitedHealth Group of Minnetonka, Minn., said the goal is merely to provide information to consumers and to help doctors improve their performance.

"Our focus is really on transparency," said Lewis Sandy, UnitedHealth Group senior vice president for clinical advancement.

UnitedHealthcare announced it would delay launching its program in New York, New Jersey and Connecticut after doctors complained and after New York Attorney General Andrew Cuomo threatened legal action.

One doctor fighting ratings systems is Seattle internist Michael Schiesser, who said his rating plummeted from excellent to the 12th percentile within a few months. He said initially Regence BlueShield, an insurer in the Northwest, ranked him in its top 90th percentile of doctors and awarded him a $5,000 check.

Later, when Regence cut him from its network and patients had to pay out-of-pocket to see him or go elsewhere, he pressed to see his report. He said he discovered that he had been penalized because of errors in data-gathering.
What other recourse do we have?

With their flawed data, it's garbage in, garbage out. Unfortunately, the potential for unfair market practices threatens the very hallowed ground the insurance industry now enjoys. With this system of proported "transparency," physicians are being proven guilty without the benefit of a fair trial.



Anonymous said...

So why don't physicians come up with a way for the public to rate them? If you ever get the free market you're clamoring halfheartedly for, us patients will probably want that.

DrWes said...


Maybe doctors don't pretend to believe we can make such "ratings" because it's not possible. Different properties define "quality" to different people or entities (insurers, etc).

Fooling ourselves that "outcomes" (for instance) is the only measure of quality, especially when a patient has a terminal illness, is meaningless - won't all "outcomes" in this situation lead to death? How do we measure "quality" in that circumstance?

Measuring clinical skill, judgement, empathy, ability to communicate - can never be totally quantifiable by a database -just as mortality measures can never be an adequate measure of a physician's competence.