Viewpoint
Confessions of a One-Star Doc
According to Medica, I am a one-star physician. I earned my star by meeting the quality measures in its Premium Designation Program, the first program to rate individual physicians in Minnesota on quality and cost. I failed to earn a second star because I did not meet the cost targets.
Although my patients haven’t mentioned this fact so far, it’s demoralizing to receive such a rating. Even more, it’s frustrating as Medica’s rating system is flawed.
For one thing, it fails to account for variability in practices and patient populations. As a family physician with a subspecialty in sports medicine, my practice is very different from that of many of my peers. This could account for some of the variation between my practice costs and those of others.
My quality ratings have been high—both according to Medica and MN Community Measurement, an independent organization that has been doing annual reports regarding the extent to which clinics and practices are meeting quality targets. Sixty percent of my diabetic patients and 80 percent of my patients with vascular disease are meeting all of the measures MN Community Measurement considers necessary for optimal care. Does providing care that is considered optimal result in additional upfront patient care costs—thus affecting the cost rating? Does spending more on prevention and management of disease pay off in fewer hospitalizations for a patient 10 years from now?
Before Medica released its ratings to the public in January, the MMA retained a national expert to evaluate the program and found three key problems:
- The fact that Medica failed to include physicians from the community in its development;
- The fact that physicians did not have enough time to review their results and provide feedback on inaccuracies and errors before the ratings were published; and
- The fact that Medica did not test the reliability of the data used to determine physicians’ scores.
Once the ratings were made public, the MMA heard from a number of physicians who found Medica had based its scores on inaccurate information about their practices. One physician reported that she was notified by Medica that she had received two stars when the website indicated she had only earned one; another who received two stars found five specific errors on his quality assessment; and a third who received two stars had actually been retired from clinical practice for 15 years.
This comes as no surprise. A study by the RAND Corporation found 22 percent of Massachusetts physicians in a similar rating program were likely to be rated incorrectly and that the current methods used to assess physician performance may produce misleading results. As a result, patients may think they’re choosing a low-cost physician only to find out that their costs are actually much higher than expected.
By not taking a closer look at the information it used to rate its providers, Medica is doing a disservice both to the physicians in its provider network and patients. In releasing results that have not been thoroughly reviewed or that contain errors, Medica may be casting doubt on all data-reporting initiatives.
So what can we as physicians do about this? If you are a Medica provider who was included in the ratings, I would encourage you to look closely at your scores and contact the MMA at MMA@mnmed.org if you notice inaccuracies or inconsistencies.
The MMA will continue to monitor this issue and press Medica to fix the flaws in its system. Our goal is to ensure patients have the accurate, reliable information they need to make informed decisions about their care.