Outcry builds over doctor-rating project

A large health system in St. Louis threatens to drop UnitedHealthcare to protest the program's unfairness.

By Robert Kazel — Posted April 11, 2005

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A new pilot program by UnitedHealthcare that purports to measure physicians' quality and efficiency, and that penalizes some patients who are treated by doctors not designated as "performers," continues to spur a backlash.

One example was the decision by the largest health system in St. Louis to drop out of United unless it agreed to revamp or scrap the initiative.

BJC Healthcare, parent company of Barnes-Jewish Hospital and nine other St. Louis-area hospitals, announced March 17 that it planned to terminate its United contracts Aug. 13 because only 18% of its approximately 4,000 doctors had been deemed "performance" physicians by the UnitedHealth Performance Program, which rolled out in January.

The insurer has told doctors that the program is sound despite many physicians' outrage over ratings they believe are based on a questionable measurement system and their resentment that they had no influence in the project's design, said Steven Lipstein, BJC president and CEO.

United's analysis of patient claims data misleads patients because the "performance" designations for many specialists are based only on cost, not quality, Lipstein said. In addition, many doctors were denied recognition due to inherent weaknesses in how the insurer does its measurements, he said.

One major flaw is that United won't assign a "performance" rating unless it has claims data on 10 patient encounters filed by an individual doctor, he said. That requirement might have little to do with how claims are filed, he said, pointing to about 1,200 physicians on the Washington University Medical School faculty who bill the insurer as a group. For the most part, they did not receive recognition as "performers," he said.

A March 10 meeting between many St. Louis physicians and company executives, which United convened after getting many doctor complaints, led nowhere, said Jon Krettek, MD, PhD, the vice president and chief medical officer of Missouri Baptist Medical Center in St. Louis.

"They staunchly refused to modify the program. It was as though 'the computer's right, you're wrong, we're going forward,' " said Dr. Krettek, whose hospital is part of BJC.

Stephen Slocum, MD, a St. Louis ophthalmologist who represented the Missouri State Medical Assn. at the meeting, said doctors there concluded, "Certainly this is a cost plan; it's not a quality plan."

United did not respond to several requests for comment.

As part of the pilot, some employers have changed health benefits so that United PPO members in certain states who visit physicians not classified as "performers" will face higher co-payments, co-insurance or deductibles. General Motors and United Parcel Service have signed on with the program already, and DaimlerChryler Corp. said it would come on board as of April 1.

DaimlerChrysler hourly employees, retirees and dependents who choose physicians from United's PPO network who are not designated as "performers" will get no coverage for office visits and physicals. Those selecting "performance" physicians will have a 50% co-pay.

Effect spreading

United's program is affecting patients and doctors in St. Louis because of the thousands of workers at a GM plant in nearby Wentzville, Mo. But its impact is being seen elsewhere. In Shreveport, La., where there's a GM plant and a UPS package-handling facility, the project already is seriously disrupting long-standing physician-patient relationships, because United members are refusing to be treated by certain doctors if they must pay more, said internist Anil Chhabra, MD. Doctors don't know why they received a "performer" designation or not, he said.

The Shreveport (La.) Medical Society sent a letter to United in March opposing the project. The Medical Group Management Assn. asked the insurer to suspend it. The AMA, the Missouri State Medical Assn., and the St. Louis Metropolitan Medical Society also have strongly criticized the program.

The only apparent change United had made as of late March was that stars next to physicians' names on the company's Web site, indicating recognition as "performance" doctors, were removed. Weeks before, a Missouri Dept. of Insurance official had warned health plans to be cautious in including such ratings for public viewing on the Web or in print.

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