Physician ratings may not help consumer decision-making

A recently published study revealed that physician-tiering guidelines and results are inconsistent across insurance companies. Furthermore, they do not fully define quality and could confuse consumers, according to a press release from the American Academy of Orthopaedic Surgeons.

The use of rating systems is expected to increase in response to the rising costs of health care and help improve national accessibility to quality care, according to the release. However, one method of physician rating used by insurance companies — physician tiering — can confuse physicians because they often are unsure of how their tier was determined, the release noted. When patients receive letters from insurers and find their doctors are not in a top tier, they too may have reactions ranging from confusion to disappointment

Orthopedists in Massachusetts

A recently published study by Timothy Bhattacharyya, MD, and colleagues is one of the first to analyze physician-tiering system data as it applies to a specific setting. The study appears in the Journal of Bone and Joint Surgery.

Bhattacharyya and colleagues examined data regarding 615 orthopedic surgeons who were accepted in one or more health plans in Massachusetts.

“Tiering ranks physicians on the basis of cost efficiency and adherence to performance quality benchmarks,” Bhattacharyya stated in the release. “Thus, a higher physician rating could lead to lower co-pays and out-of-pocket costs for patients.”

Study limitations

The study also revealed concerns that the authors felt should be addressed, such as the fact that indicators of quality, including years in practice and fewer malpractice claims, did not influence or factor into tier rating.

Bhattacharyya and co-authors suggested that tiering data needs more exploration and a clearer definition of quality. They also noted that more information needs to be provided to patients about physician tiering, according to the release.

Study limitations included the fact that data were examined for one specialty in one state and may not be applicable to other medical specialties or geographical areas. Lack of agreement between health plans may be the result of measuring different aspects of health care quality. A “gold-standard” consensus could serve as a benchmark and provide consistency across plans, according to the release.

References:
Wadgaonkar AD, Schneider EC, Bhattacharyya T. Physician tiering by health plans in Massachusetts.J Bone Joint Surg (Am). 2010; 92(12):2204-2209.
www.aaos.org

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