Minnesota doctors ask for delay in Medica ratings

  • Article by: MAURA LERNER , Star Tribune
  • Updated: January 17, 2011 - 10:15 PM

Medica debuts its marks for 9,400 physicians on Wednesday.

A plan to rate thousands of Minnesota doctors on quality and cost, due to be published Wednesday, has drawn objections from the Minnesota Medical Association (MMA) even before its release.

Medica, the state's No. 2 health plan, is scheduled to unveil the new ratings on its website as part of a growing movement to give consumers more information about quality of care. It's the first time Minnesota doctors will be rated by name, using a star system to show how they perform on a variety of national cost and quality measurements.

Last week, Dr. Robert Meiches, the MMA's chief executive, asked Medica to delay the rollout, saying the rating system is prone to errors and unfair to physicians. "Medica appears to be rushing to publish results that, given current science, have a strong likelihood of misclassifying physicians," Meiches wrote in a Jan. 13 letter to the insurer.

The MMA says one doctor, for example, was cited for failing to give a mammogram to a patient, even though the patient had left that practice. Another was accused of failing to give a routine Pap (cervical cancer) test to a woman who no longer needed it because she'd had a hysterectomy.

Medica, however, says it has no plans to delay the program, which has been in the works for more than a year.

"We're planning on going live with the results on Wednesday [at www.medica.com]," Dr. Charles Fazio, Medica's chief medical officer, said Monday.

The ratings system, known as the Premium Designation Program, is part of a national effort to show consumers how their doctors and hospitals compare to one another. It was developed by UnitedHealthcare of Minnetonka and is used in nearly 140 other places in the country.

"What we're doing is responding to a need that we hear from consumers and employers," said Fazio.

Medica calls it "the next evolutionary phase" in the push for transparency in Minnesota health care. Until now, clinics and hospitals have been rated by groups such as Minnesota Community Measurement, but not individual physicians.

Under the new program, Medica plans to post the ratings of more than 9,400 doctors in 20 medical specialties, including family medicine, cardiology, pediatrics, orthopedics and internal medicine. It analyzed claims data from 2007 to 2010 to evaluate how closely each doctor adhered to national treatment guidelines for diabetes, high cholesterol and other common conditions. Doctors get one star for meeting or exceeding national standards, two stars if they're also cost-efficient.

Above average?

In all, nearly 50 percent of the Medica doctors got two stars, 20 percent one star, and only 8 percent got no stars, the lowest rating, Fazio said. The rest had too few patients in any category to qualify. In effect, he said, "70 percent of them are above average."

Medica started notifying doctors of their ratings in early December and gave them until Christmas Eve to appeal. The medical association said that didn't give doctors enough time to review the accuracy of the ratings, especially over the busy holiday season.

Still, a number of doctors discovered errors in their evaluations, the MMA said.

"Among the problems reported to the MMA are errors in specialty designation, inclusion of retired physicians" and demerits for "failing to provide follow-up care to a patient that has actually moved out of state," the MMA said.

"The data can be totally wrong," said Dr. Patricia Lindholm, the MMA's president and a family physician in Fergus Falls. "If a doctor starts losing patients based on a faulty score ... that is a fairly serious thing."

Lindholm said some doctors have been baffled by their scores. "I'm not sure what the threshold is for getting a star, either," she said. "I got two stars, but I don't know why."

Lindholm said she's also skeptical the ratings will have much meaning for consumers. "I don't think you're going to find either good docs or bad docs through this kind of program."

System will evolve

Fazio, of Medica, admits the system isn't perfect. But he said it's one way to shine a spotlight on the way medical care differs from doctor to doctor in ways that affect both cost and quality. "We think it's a pretty good system. And it's a system that will evolve over time," Fazio said.

So far, only about 150 doctors have complained about their evaluations, Fazio said, adding that Medica will continue to correct inaccuracies brought to its attention.

No financial rewards or penalties are tied to the ratings right now, he said. But that may change eventually. At some point, health plans and employers may start giving patients a financial incentive to choose two-star doctors.

"I expected that there would be pushback, and obviously there has been," Fazio said. "But there have also been a number of people [who] have come forward and said 'This is great. This is exactly what we need to know.'"

Maura Lerner • 612-673-7384

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