MMA Viewpoint
Peer Grouping Must Be Fair to Physicians
Nothing is more important to physicians than their reputation with their patients. That’s why the MMA made improving the state’s peer-grouping initiative a top priority during the 2010 Legislative session and why successfully changing the peer-grouping law was an important victory for doctors.
Minnesota and other states are seeking ways to evaluate and compare providers in order to encourage patients to seek low-cost, high-quality care. Minnesota is doing this through its peer-grouping initiative, which will compare clinics and hospitals on cost and quality. Providers will get a first look at their scores this fall.
The MMA supports the idea of providing patients with more information about providers but is closely monitoring peer grouping because efforts to evaluate physicians are complex and have been fraught with difficulties. For example, physicians are at a strikingly high risk of being miscategorized when rated by cost-profiling programs, according to the findings of a study by RAND Corp. that were published in the March 18 New England Journal of Medicine. The RAND researchers created a mock profiling program based on real claims data and found that it misclassified as many as 22 percent of physicians, and that about two-thirds of its ratings were less than optimally reliable. The bottom line is that current methods for profiling physicians with respect to the cost of services may produce misleading results.
In other states, efforts to profile physicians have led to lawsuits and acrimony. In May, 35,000 California physicians withdrew their participation in Blue Shield’s new Blue Ribbon rating system. Under the system, physicians who rank highly on quality indicators receive blue ribbon icons next to their names in Blue Shield materials. The California Medical Association objected to the ratings saying they failed to truly characterize the care patients received. For example, one physician reported that he was marked down for not recommending cervical cancer screenings for patients who had undergone hysterectomies.
The Massachusetts Medical Society has gone to court to change a ranking and tiering program implemented in 2006 by the Massachusetts Group Insurance Commission and two health plans. The medical society contends the program has defamed physicians and defrauded consumers. For example, one physician found that 68 percent of the patients attributed to him were not his. He had merely interpreted their EKGs or exercise tolerance tests and had no influence on the cost of their care.
As one can see, physician ranking can go awry. Minnesota is avoiding some of these pitfalls. For example, our peer-grouping initiative is not trying to rank individual physicians, nor is it trying to hide its methodology. In addition, it is trying to incorporate approaches such as providing rankings that are not solely cost-based and are risk-adjusted.
However, the original plan for Minnesota’s peer-grouping program did have flaws that physicians wanted addressed such as an unrealistic timeline for implementation and a punitive approach.
Because of MMA efforts, peer-grouping data now must meet standards for reliability and validity before being released to the public. In addition, providers who fall in the bottom 10 percent on quality and cost measures will no longer be precluded from treating patients covered by state-subsidized health insurance. The law also extends by one year (to January 2012) the deadline for health plans to start using the data.
Time will tell if the data produced by peer grouping will be useful and fair. But at least the physicians of Minnesota now have additional legal protections.