There has been a trend by some insurance companies (united health care being a major one) to try and base doctors reimnursements and preferred listings on "quality". This has been a hot topic in several states.
It sounds good..bad doctors get weeded out out and good doctors get paid more. Or if you don't visit one of the insurance companies 'preferred quality" doctors you have to pay a higher co pay.
But who and what determines quality? Do we really want the inusrance companies who have a financial interest in a doctor's treatment determining who is good and bad? How do a quantitate a specialty like rheumatology where there is virtually no quantitatable data. You can't quantitate the ability to listen or superior diagnositic ability.
A doctor who thinks outside the box or who may spend more time with a patient may not make the cut because they aren't cost effective. A doctor who takes on high risk patients may be dropped because their outcomes may not be as good as someone who doesn't take risky patients? Should a doctor with non-compliant patients be penelized because his patients dont' follow orders-for example not getting a mammogram.
So what do you think..if doctors insurance pay and listings are based on performance who should set the standards and how should they be determined
First of be careful using some of those Ginormous words (quantitate) You might scare some of us less educated people. "HaHaHa"
I feel it is almost imposible to measure Quality Health Care for the same reasons you brought up. There are simply too many variables.
Jay
You have got to be kidding me; this is the trend!
Got any articles on this subject. Anything so I can get up to speed.
What will they think of next. And see how easy it's going to be to sell this to the companies that offer health plans.
Pip
http://www.pittsburghlive.com/x/pittsburghtrib/business/s_49 2216.html
http://boston.bizjournals.com/boston/stories/2006/12/04/stor y11.html?jst=s_cn_hl
I think it is terrible that insurance companies would rate the doctors. I think it is impossible to even ask the patients. Some patients will never be happy no matter how good the doctor is.
As for United Health Care, this is just another way for them to cheat us out of our coverage. My rheumy started his own practice this past December with the goal of being a participating physician with all the health insurance companies so that we can all afford treatment. He applied 9 months ago with UHC and is still waiting for approval. I called to find out what the hold up is and UHC told me that can't help me because of confidentiallity issues. They just want to drag it out so they don't have to pay for our treatments. It has already cost me over 0 personally and lots of stress because of their delay. I don't want them deciding which of my doctors are good and which ones are bad.
I've had UHC in the past. I found them to be a terrible insurance provider. Based on that I'd have to disagree with what they are trying to do. They always seemed to want to find a way out of paying a claim and it seems to me that this is just another ploy.Buckeye -
By the time I got to this the link for boston boz journal didn't work. But I got to say - I hit it on the head about employers jumping on this bandwagon. What did it say - 5 - 9 % in premiums?
The part that scares me the most is they want to be able to electronically view our records - and I'd bet the farm HIPPA wouldn't cover us. We're hosed.
What if we have a mis-diagnosis in our files?
What if we choose non-mainstream meds - like, oh, AP?
What if we need more time with the doc.
This is truly frightening.
Pip