State doctors say rankings should focus on quality, not costby Lorna Benson, Minnesota Public Radio
The state's largest doctors group has given a mixed review to the growing trend toward physician tiering. Three health plans and the State of Minnesota offer so-called tiered insurance products, that differentiate between physician clinics based on the cost and quality of their services. Patients who choose doctors in the plans' preferred tiers typically pay lower insurance premiums or co-payments.
St. Paul, Minn. — In its report, the Minnesota Medical Association says all three health plans scored moderately well on the type of tiering information they provide to enrollees and physicians. But the MMA gave low scores to the state's tiered plan.
The MMA decided to grade physician tiering plans after hearing a number of complaints from its members. Some doctors were concerned that the information used to slot their clinics into tiers might be wrong or incomplete.
CEO Bob Meiches says the MMA isn't saying the doctors are right or wrong. But he says their concerns do point out weaknesses in current tiering systems.
For example, Meiches says it's not always clear how health plans determine which tier to place a clinic in. And he says there is very little consistency from one health plan's tiering network to the next.
"How can you be in one health plan in the most efficient, best-quality tier and in another one, in the opposite tier? It doesn't make sense," he says.
Meiches says in order to be effective, tiering must be consistent and transparent. Otherwise, he says, consumers won't be able to make good decisions when choosing a tiered plan.
"If those things are not accurate and not done well, then all this information is wrong," says Meiches. "And if the information is wrong, then we're giving information to consumers about the wrong quality of care and the wrong cost of care, the wrong comparisons -- and that's really an issue."
HealthPartners, Medica and Blue Cross Blue Shield of Minnesota received middle-of-the-road scores from the MMA when ranked on the amount of cost and quality information they make available to physicians and consumers.
The state's Minnesota Advantage plan received low marks. The MMA says the state plan is the only one that doesn't use any quality measures in assigning tiers.
Matt Kramer, Commissioner of the state Department of Employee Relations takes issue with the way the MMA graded the state.
"I think they're a little bit off base. They focused exclusively on, 'Does the plan provide quantitative measurements of quality?' -- that is, outcomes. And we've never pretended otherwise, that this is a cost comparison -- which is one aspect of the consumer's decision," says Kramer.
Kramer says the state isn't in a position to measure clinic quality, because it contracts with three health plans that aren't inclined to share that data with each other.
Instead, he says the state points its employees to a Web site run by the Minnesota Community Measurement program, where employees can find quality comparisons between clinics.
Kramer says many employees use the site to help them decide which clinic to choose. But state employee Tracy Close wasn't one of them. He was unaware that he could find information on his clinic's quality when he picked out his tiered plan last October.
"I did not get the feeling that there was anything related to quality of service," says Close. "There may have been, but it didn't strike me that way."
But Close says even if he had seen the quality information, it probably wouldn't have mattered much anyway. He says it wouldn't have been specific enough to help him make an informed decision about his doctor.
"In a situation like mine where we're looking at my clinic, which is Duluth Clinic, I mean how many doctors are there? And they don't ask you who your primary care physician is, so you really have no way of determining what their quality is, compared to other individual doctors in the same clinic," he says.
Close says he would like to see individual rankings of doctors someday, but he says until then, pricing information is probably more important to him than quality measurements, based on the performance of a group of doctors.
That sentiment troubles the MMA. The organization says it supports efforts to give patients more information, but only if that information tells the whole story - in this case on cost and quality.