Sunday, December 16, 2007

Physician Profiling

It's official. Doctors are being discriminated against.

We're being profiled.

By our own AMA.

Buffalo (NY) physician Nancy Nielsen of the AMA, worked with New York Attorney General Andrew Cuomo to develop the model to profile doctors.

But in a remarkable display of double-speak, we find:
"The AMA commends Independent Health for voluntarily joining the ongoing shift in the health insurance industry's stance on physician profiling," Nielsen said. "Although Independent Health does not profile physicians, its agreement with the Attorney General indicates that a primary commitment to quality improvement already exists within the company."

So the AMA commends Independent Health for joining the physician profiling although Independent Health does not profile doctors.

And the AMA commends them for this behavior.

From the Wall Street Journal:

Over the next year, the rankings will become more transparent and thorough under agreements reached in recent months between several of the biggest health insurers and New York Attorney General Andrew Cuomo. Aetna, Cigna, UnitedHealthcare and WellPoint have said they'll apply the agreed-upon approach to their ratings nationwide.

The insurers have agreed to rate quality as well as cost and to use independently accepted criteria -- which might include, for example, measures from the not-for-profit National Committee for Quality Assurance -- instead of just claims data to rate physicians. They also will adjust for risk so that, for example, a doctor is not
penalized for handling more complex cases that may result in higher costs and more

Additionally, doctors will be able to review the data and appeal the decisions.
Now I touched on this before, but since it now seems that the National Committee for Quality Assurance (NCQA) from Washington DC "might" be developing the ranking criteria, I thought I would see who will be doing this important task.

Here are some of the positions the NCQA needs filled right now (according to their website). I've included my comments about each one in italics:
Assistant Director
The Assistant Director (Focus on Health Promotions & Disease Management) will manage and coordinate measure and program development and implementation activities (e.g. MAP/ expert panel meetings), including establishing goals and strategies and generating new ideas.

In other words, this person has no idea what he's to do, but "wellness" strategies and removing sick people from the insurance rosters will help future rationing strategies for healthcare.

Assistant Vice President, Product Development
The Assistant Vice President will provide NCQA leadership in California with its large number of NCQA customers and significant managed care market; to do so by working with a variety of organizations to make NCQA evaluation tools relevant to them; and to identify business opportunities for NCQA and be responsible for carrying them out This involves establishing California relationships; understanding the environment in California, understanding NCQA products and capabilities and directing California-based and headquarters-based NCQA resources.

California doctors, you're screwed. It seems your managed care market is particularly perplexing since the "environment" is less than tasteful to "organizations" like insurers and government. Therefore, doctors will be really ranked there. Oh, and what "relationships" are they talking about that need to get "established," any way? Glad I work in Illinois.

Chief Information Officer
The Chief Information Officer (CIO) is responsible for providing data & technology vision, and strategic direction, for developing and implementing information technology (IT) initiatives and information products that support NCQA's mission. The major purpose for this role is to lead the creation of a significant data strategy, which will support performance measurement within the health care system.

You see, the data strategy still needs some work. And the data systems to update the voluminous quality data points aren't ready quite yet, so the updates to the ranking websites will not be in real-time. That will take the hire of ten more IT specialists to implement. Estimated date of completion: 2062.

Manager, Data Collections

The Data Collections Manager will oversee and manage HEDIS data submission operations and staffing (3+ staff positions), including non-survey HEDIS data and survey HEDIS data (CAHPS, HOS, etc.).

There are never enough people to measure the data. Never mind they have no idea what it all means. Rest assured the data, however, will be transparent as they'll publish it quickly.

Manager, Information Products
The Manager, Information Products will lead day-to-day management of Health Plan Report Card redesign project, including planning, analysis, testing, implementation, and training for immediate and longer term development phases.

Once they have the data, they plan to sell it as their "product," I guess.

Policy Analyst
The Policy Analyst will analyze questions, research content; prepare accurate written responses to questions for customers and for discussion at internal meetings and serve as an internal resource to organizations.

Hmm. Which "organizations" exactly will this person serve as a resource to? Doesn't sound like they're a resource to patients. Could it be the insurance agencies? CMS?

Policy Analyst (HEDIS)
The Policy Analyst (HEDIS) prepares standard written responses to customers through the Policy Clarification Support system. This person serves as an internal resource to organization.

Everyone needs, wants, and understands a "Policy Clarification Support" system that explains what all the verbiage means and supports other organizations like the insurance industry.

Policy Manager
The Policy Manager will serve as product and content experts for assigned accreditation and certification products. This person will provide direct support and clarification on complex questions regarding Standards and Guidelines and associated HEDIS measures.

So much policy, so little time. A "Manager" is certainly needed here, especially for all those "Standards and Guidelines!"

Senior Health Care Analyst
The Senior Health Care Analyst will establish goals and strategy; manage and coordinate measure development process in assigned areas, including prioritization of measures and issues, assessment of measures, and development of specifications; develop pilot testing strategy and implementation of measures.

What are these guys goals and strategy? I thought they were ranking doctors. How hard can this be? I mean "prioritization of measures and issues?" You mean, not all measures are created equal? How are the measures "prioritized," by coin toss?

Senior Health Care Analyst (Focus on RRU & CMS)
The Senior Health Care Analyst will establish goals and strategy; manage and coordinate measure development process in assigned areas, including prioritization of measures and issues, assessment of measures, and development of specifications; develop pilot testing strategy and implementation of measures.

Just like the last guy, only more, since he reports to our Government.

VP, Product Development
The Vice President is responsible for leading the product Development Department in execution of opportunities or organization growth, while keeping NCQA in the forefront of the quality movement in health care. He/she will have primary responsibility for evolving NCQA evaluation products to advance our mission.

In other words, the sales of the quality assurance "Product" will assure the maintenance of the NCQA's remarkable budget and bureaucracy.

Incredible display, eh? So many people hell-bent on physician profiling and "transparency."

All supported by the AMA in concert with the insurance industry.

But in the end, Even the AMA's own believe we'd be better off ignoring the rankings and listening to friends and nurses:
But "at the end of the day most of us rely on friends, family and word of mouth" to choose a doctor, says Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change, a research group in Washington. She recommends asking a trusted pediatrician, internist or family physician for a referral to a specialist. If you don't have a doctor, ask friends and family for recommendations.

Hospital nurses also are a great resource. "They know who is nice, and they know who is good," says Dr. Nielsen of the AMA.
Funny how the nurses never seemed to mention Dr. Nielsen.


No comments: