MMA News
MMA Finds Significant Errors in Medica’s Physician Ratings
The MMA launched a media campaign in January to educate the public about the unreliability of Medica’s Premium Designation Program, the first program to attempt to rate individual physicians in Minnesota.
The MMA supports measuring the performance of clinics and physicians at the group level but opposes Medica’s program because of its methodological flaws and potential to harm the reputation of individual physicians.
The ratings program, developed by United Healthcare, attempts to measure the performance of board-certified physicians on measures of care quality and cost efficiency. Physicians are first evaluated on quality. If they meet quality standards, they are further evaluated for cost efficiency. Physicians can receive up to two stars, with two stars indicating that they met the quality and cost-efficiency criteria. One star shows that they only met the quality criteria; no stars signifies that a physician failed to meet the quality criteria. Medica rated approximately 9,400 Minnesota physicians.
The MMA asked Medica to delay implementation of the rating system after reviewing an extensive analysis of the program by J. William Thomas, Ph.D., an economist and expert in the measurement of provider performance from the University of Southern Maine. A review by researchers from RAND of a similar physician-rating system in Massachusetts found that 22 percent of physicians were likely to be misclassified.
Thomas found that on the whole, the program was well-designed and met most of the certification criteria currently specified for such programs by the National Committee for Quality Assurance. But he also found three shortcomings: a lack of reliability testing to assure statistical accuracy of the results, lack of Minnesota physician involvement in the development of the system, and an inadequate amount of time for physicians to review their rating and the data underlying it. Because of those deficiencies, Thomas concluded in his report to the MMA: “In spite of the program’s strengths, however, its implementation by Medica has several shortcomings, and these, if left uncorrected, could compromise the program’s long-term objectives of improving quality and controlling costs.”
MMA leaders shared Thomas’s concerns with Medica in December and January, as well as reports from physicians whose data contained errors. For example, Medica penalized one physician for failing to order a Pap test when, in fact, the patient had had a total hysterectomy nine years earlier. Medica penalized another for failing to do a strep test when the test had indeed been completed.
Because Medica had not informed the MMA as to whether it still planned to roll out the ratings by the middle of January, the MMA decided to go public with its concerns just days before the scheduled launch on January 19.
A media campaign by the MMA resulted in coverage in newspapers and on radio and television programs throughout Minnesota. However, it did not stop Medica from rolling out the ratings as scheduled. The MMA has hired an attorney to look into legal options for halting the program, although given the expense, a legal challenge is unlikely.
To read J. William Thomas’s full analysis, go to www.mnmed.org/medica.
4 Things about Medica’s Rating Program the Media Got Wrong
The MMA’s efforts to delay Medica’s Premium Designation Program received extensive media coverage in January. Here’s a look at a few of the false claims in those stories.
- This is a helpful tool for patients. Given the unreliability of the data and the good chance that physicians could be misclassified, relying on this rating system could lead patients astray. This information would be most useful if given confidentially to physicians so they could review their patterns of care and utilization of services.
- Data are incorrect for only a small percentage of physicians. Medica claimed in media reports that only 150 physicians reported errors. That figure, however, only represented the formal requests for reconsideration of results. The MMA has received reports that have yet to be filed. In addition, considering the significant time it takes to review the data and compare it with documentation in patients’ charts, it is likely that only a small percentage of physicians even checked their data in the limited time allowed by Medica.
- Physicians simply want to stand in the way of performance measurement and reporting. There is no basis for such a comment. The MMA was a founding member of MN Community Measurement and has supported state and federal efforts to expand performance measurement.
- The MMA thinks it is “unfair” to rate doctors. The MMA supports transparency and the public reporting of physician performance at the group and clinic level. The problem is that Medica chose to bring forward a program with known errors.
MMA Opposes Repeal of Health Care Reform Law
In January, the MMA sent a letter to Minnesota’s congressional delegation announcing that it was opposed to attempts to repeal the Patient Protection and Affordable Care Act (ACA) that was signed into law last year.
The letter was sent to all eight of Minnesota’s members of the U.S. House of Representatives after the MMA’s executive committee voted to oppose efforts to repeal the ACA. The House voted in favor of repealing the law on January 19.
Although the MMA did not take a position on the ACA while it was being debated in Congress last spring, it decided to oppose repeal of the ACA because many of its key provisions align with MMA policies and the MMA’s vision for reform. For example, the MMA supports an individual mandate for the purchase of health insurance, insurance reforms, government subsidies to help low-income individuals purchase insurance, and reformed payment systems such as medical homes.
Furthermore, the MMA believes that it would be more effective to focus on fixing specific problems in the ACA rather than repealing the law and having to start from the beginning.
“In reviewing the provisions of the ACA, the MMA has found many items that are aligned with the recommendations in our 2005 report [Physicians’ Plan for a Healthy Minnesota],” wrote MMA President Patricia Lindholm, M.D., in the letter sent to the Minnesota delegation. “There are also some provisions in the ACA that cause us some concern. But the MMA remains committed to achieving insurance coverage for all Americans, eliminating insurance industry abuses, changing payment systems to reward high-quality, efficient care, and reducing health care costs. Although imperfect, the ACA begins to address each of these goals, and repealing the bill will only slow down this country’s progress in tackling these challenges.”
From the President’s Blog
The following is an excerpt from MMA President Patricia Lindholm’s blog entry from January 20. It was posted after she and other MMA leaders spent a busy week talking to the press about Medica’s individual physician rating program. The MMA launched the President’s Blog last October. To read the full entry or subscribe to the blog, go to http://mmapresident.blogspot.com.
You may have seen or heard me, Past-President Ben Whitten, and others representing the MMA in the press recently. We have been working hard to put forward our members’ concerns about Medica’s flawed individual physician rating program.
Despite our efforts to work with Medica behind the scenes and in public, Medica decided to ignore the feedback of physicians and move forward with its program.
The MMA is concerned about known errors in the data, the inadequate time allowed for review and validation, and the insufficient statistical testing of the results. Medica’s program could harm physicians’ reputations, undermine the physician-- patient relationship, and mislead its members and purchasers of health insurance. We felt the MMA’s request that Medica address our concerns was reasonable and justified. I am saddened that Medica chose to ignore our concerns and dismiss our overtures to work together. Minnesota has had an admirable culture of collaboration between health care providers and insurers in the past. To ignore the input of physicians is not in that spirit.
Medica has truly missed a chance to work with physicians to design a useful tool and strengthen its relationship with the physician community.