Minnesota's second-largest health insurance plan says it will go ahead with Wednesday's launch of a website where it provides quality ratings of physicians, despite complaints from the state's largest doctors group.
The Minnesota Medical Association says Medica's new ratings program is filled with errors, and is therefore an unreliable and misleading tool for consumers. Medica says any errors that doctors have identified so far have been fixed.
Medica's new website tool is called the Premium Designation Program. It was created by Minnetonka-based UnitedHealthcare. The tool measures the quality of care and cost effectiveness of individual physicians in 20 specialty areas.
Doctors deemed to provide high-quality care get one star. If their care is also not overly expensive, they'll get a second star. Doctors who don't meet either criteria get no stars.
Medica says 89 percent of the Minnesota doctors who received performance ratings got one or two stars. That percentage is higher than any of the other markets that are currently using the web tool.
But some doctors still aren't happy.
"Ranking is one thing and it may be very helpful, but inaccurate ranking is extremely harmful to people's reputations and to their practices," said Patricia Lindholm, president of the Minnesota Medical Association, the state's largest doctors organization. She's also a family physician with a practice in Fergus Falls.
Lindholm has fielded numerous complaints from her members about the new ratings tool. She says it penalized one doctor for failing to order a cervical cancer test on a woman who had no need for one, because she'd undergone a total hysterectomy nine years earlier.
Another doctor had been penalized for failing to do a strep test on a patient, even though the test had been done.
"If the data were reliable and consistent and we could trust it, maybe it's appropriate to steer people to doctors who practice more cost-efficiently and with high quality," said Lindholm. "But if we don't have reliable information, I don't think that we can fairly direct patients one way or the other."
Medica's chief medical officer, Charles Fazio, acknowledges the web tool isn't perfect. But he says out of the 9,500 doctors who had enough claims information to be rated, only 150 -- or less than 2 percent -- have reported problems with their results. And he says all of those cases were resolved quickly.
"We have said all along -- if there are mistakes in the data, we're going to improve them or correct them," said Fazio. "That doesn't stop today or tomorrow, just because the website goes live."
Exactly what is a sufficient standard for accuracy is a key part of the dispute.
Bill Thomas is a retired economist from the University of Michigan who was hired by the MMA to review Medica's web tool. Thomas says the product meets current guidelines established by the National Committee for Quality Assurance.
But he believes those guidelines are not sufficient, because they don't require that the data be vetted for reliability, "so that if a physician is classified as having two stars and the physician's scores are highly reliable, we can be very confident that those two stars are indeed accurate and earned."
Thomas says the NCQA's guidelines for ratings systems are being revised this year, and he predicts they will require insurers to do more to ensure the accuracy of their ratings data.
Yet some Minnesota doctors already see value in Medica's new rating system. Dan Buss, an orthopedic surgeon from Minneapolis, received two stars for providing high-quality, cost-effective care.
But Buss says when he examined the case files used to determine his score, he noticed that the computer system had flagged a potential followup issue involving one of his patients.
"One of my patients had never gone to physical therapy after his surgery," said Buss. "And lo and behold, he'd never come back to see me after his surgery."
Buss says that was an oversight that he probably wouldn't have flagged on his own.
"That triggered us to recognize that we need an internal mechanism to monitor when someone doesn't come back for an appointment after a major surgical reconstruction, that we get them on the phone and make them come back in," he said.
For now, Medica is providing its ratings solely as a consumer information tool. But the health insurer has not ruled out tying higher or lower co-pays to the doctors, depending on their ratings in the future.
The ratings will be published at medica.com.