Doctors, insurers, consumer groups, employers and labor unions have agreed on standards to rate U.S. physicians, which are increasingly used by health plans.
The standards will eliminate consumer confusion and inconsistencies among health insurers, including UnitedHealth Group and Aetna, that guide members to doctors scoring highest on cost and quality, the coalition said in a statement Tuesday.
The agreement calls for independent third-party review of the ratings, allows challenges by doctors and requires that ranking methods ''be published and made readily available to the public,'' according to the coalition.
Bernd Wollschlaeger, president-elect of the Dade County Medical Association, said Wednesday that he personally supports the effort. ''Doctors should be pro-active'' in supporting accurate ratings efforts. ``If you don't sit at the table, then you're a menu item on the table.''
''You've got basically everybody in the system agreeing that this is the way this should be done,'' said Susan Pisano, a spokeswoman for the Washington-based trade group America's Health Insurance Plans, in a telephone interview. ``These are efforts that no one stakeholder can work on alone.''
The parties to the agreement included AARP, the AFL-CIO unions, groups advocating improvement in the practice of medicine, the American Medical Association and other physician organizations.
The agreement was spearheaded by the Consumer-Purchaser Disclosure Project, a group of consumer, labor and employer organizations working for public access to healthcare performance information. The talks have been going on for several years, Pisano said.
''This is most likely to succeed with full disclosure of the methods and standards used to evaluate the way health plans create physician tiers and report on physician performance,'' said John Rother, policy director of the Washington consumer lobbying group AARP, in a statement.
Santiago Leon, a Miami insurance broker and co-chair of Healthcare for All Florida, said the proposal sounded good, but would be hard to implement. Customer satisfaction surveys of patients ``may measure a good bedside manner, but not quality of care.''
Data from insurers' claims may also not be detailed enough to measure performance, Leon said. He praised the Rand Corp. for doing detailed ''chart studies'' in doctors' offices, which can be revealing, ``but that requires a lot of skilled labor and would be very expensive.''
Participating insurers in Wednesday's agreement included UnitedHealth, Aetna, Cigna Corp., and WellPoint.
Those companies yielded last year to demands by New York Attorney General Andrew Cuomo that they change the way they rate doctors. The agreements came after Cuomo began to investigate claims that insurers used ratings to send patients to cheaper doctors rather than better ones. The disclosure coalition participated in talks with the insurers and Cuomo.
Cuomo is also investigating the methods used by insurers to calculate fees paid to doctors who don't participate in their provider networks.
Miami Herald business writer John Dorschner contributed to this report.
