AMA pushes for more useful explanations of physician performance data and methodology

Multiple health care organizations — including a few insurers — have pledged support for a set of guidelines developed by the American Medical Association that attempt to standardize and improve the way physicians are notified of their ratings by health plans, and the methodology used to reach those scores.

The “Guidelines for Reporting Physician Data” call for a reader-friendly notice to physicians that is consistent across insurers, so that physicians wouldn’t have to wade through widely varying sets of data displayed in a different way by every insurer.

“Almost every public and private health insurer presents physicians with practice profile reports to support data-driven decision-making,” AMA President Jeremy A. Lazarus, MD, said in a statement about the new guidelines. “This feedback has been ineffective since the complex reports vary from plan to plan and are difficult to read and interpret.”

UnitedHealth Group, Cigna and BlueCross BlueShield of Tennessee signed on in support of the guidelines.

United explained its decision to support the guidelines in a company statement: “We share the AMA’s goal of facilitating standardization in the process of providing physicians with performance-related information so as to assist them in optimizing the quality, cost effectiveness and patient satisfaction with clinical practice and thereby meet the goals of [the Institute for Healthcare Improvement’s] Triple Aim [initiative]. We also realize that standardization is essential to the reduction in the administrative burden associated with this type of reporting.”

The AMA also gained the support of a wide range of other organizations, including state and specialty medical societies, the National Committee for Quality Assurance and the Midwest Business Group on Health.

According to the AMA’s introduction to the guidelines, the principles are meant to be “aspirational,” so endorsement doesn’t necessarily mean that an insurer promises to follow them to the letter, just that they agree with the ideas the AMA brought forward.

In a letter asking for support of the guidelines, AMA Executive Vice President and CEO James L. Madara, MD, said the AMA had met with insurers and medical societies to ask insurers to adopt a standard form developed by the AMA for notifying physicians of their profile results.

“Although the form was generally well-received by the group, it quickly became evident that there were significant costs associated with having all physician reporting bodies adopt this form,” he wrote. “The group, therefore, refocused its efforts on creating a set of guidelines for optimal reporting of these data.”

Dr. Madara continued, “While we understand that physician profiling entities may be unable to immediately implement all aspects of these reporting guidelines, we urge you to formally support their essence and their intended purpose of increasing physician understanding and use of their data for practice improvement. We also encourage you to implement as many of their concepts as possible into your own physician data reporting system.”

The trade group America’s Health Insurance Plans and the Pacific Business Group on Health, an influential business-insurance coalition, have refused to endorse the guidelines, saying they are too rigid and could overlap with similar initiatives already under way.

Although the signature of support doesn’t require insurers to follow them to the letter, AHIP and the PBGH said in separate letters responding to the AMA, that the reporting guidelines are too “prescriptive,” potentially stifling innovative ways of profiling physicians. “AHIP supports the goal to standardize physician performance reporting across both private and public sectors to promote systemwide improvement and physician and consumer engagement. However, due to several concerns with the AMA guidelines as drafted, we cannot support their use as currently written,” AHIP’s letter said.

AHIP and PBGH said that any such guidelines should apply to public as well as private payers, and that the principles overlap with some already endorsed as part of the Patient Charter that major insurers signed in 2008.

The Patient Charter, signed at the urging of a consumer-business coalition led by the PBGH, outlined the best practices for physician profiling and was embraced by insurers as preferable to the potential alternative -- having to meet different standards in every state. The Patient Charter focused on ensuring that physician profiling was based on robust, agreed-upon quality measures.

The AMA’s Guidelines for Reporting Physician Data are solely concerned with the way the scoring data and methodology are communicated with physicians, something the AMA did not feel was addressed in previous agreements like the Patient Charter.