How quality ratings blew up in an insurer’s face

September 22, 2006

This is what you get when bureaucrats run health care – a laughable physician quality measure:

He found, for example, that he was faulted for poor treatment of two diabetes patients. The patients in question didn’t have diabetes, he said.

Another doctor got a bad rating for failing to order a mammogram for a patient who had already had a double mastectomy, said W. Hugh Maloney, WSMA’s president.



Related posts:

  1. Physician ratings: "Who did you kill?"
  2. More physician ratings
  3. More folly on doctor ratings
  4. Does good bedside manner mean a better doctor?
  5. Quality measures
  6. Think your insurer denies tests now?
  7. Physician ratings


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{ 2 comments }

1 Gasman September 22, 2006 at 11:39 am

The insurer had better contact their own insurer. Once they publish an incorrect negative review of physicians, reputations are tainted permanantly because the data will always in the future come up in a search of the internet. Even though the insurer might correct the rating their damage to the doc and his business will continue. Expect some lawsuits here when physician ‘report cards’ are incorrect.

2 Anonymous September 22, 2006 at 11:43 am

Please Explain to me why doctors (espeicially primary care) are so infatuated with the current reimbursement system. A system which rewards high volume with no regard to quality is a bad one that needs to be changed. Obviously there is need for care in making this change that you don’t create other problems, but we are due to get an additional $20k per year for participating in the Bridges to Excellence program. This is due to our high quality diabetic care. It is gratifying that my sacrifice of spending time with my diabetic and getting paid less than the doctor down the hall who sees 50 patients per day will finally be rewarded in ways other than a good feeling inside. I am really getting tired of physicians attacking P4P when it is really about righting a wrong.

The truth is, many in the payor community feel the wide disparity between primary care and specialists is part of the problem. If you pay primary care physicians more for doing good medicine and keeping patients out of specialist’s offices (by preventing complications of disease) and keeping patients out of the hospital, it is an investment well worth doing.

Doesn’t it bother you that a dermatologist, opthalmologist, cardiologist, etc. can make many times your income when you in fact are more important in more people’s lives? Primary care is undervalued. Done right, P4P offers a way to increase compensation for the PCP’s who do a good job.

Instead of focusing on the failings of P4P, why not find a way to make it work better for the sake of PCP’s, patient care, and the survival of our healthcare system? American healthcare sucks. IMO, it sucks because we pay more for lousy medicine than we do good medicine. Am I wrong?

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