Generally speaking, it's difficult for providers to accept the results of studies that rate their quality and efficiency. Why, then, aren't we hearing more complaints about the ratings payers impose on the providers in their networks?
Supposedly, such ratings are there to help consumers find the highest quality, most efficient providers. In practice, though, we all know that payers want one thing—cheaper care that doesn't actually kill the patient—and that any provider that's highly ranked by a payer is probably delivering the least care.
Payer self-interest
Now, doctors and hospitals on the low end of the care delivery scale may be perfectly fine, but they shouldn't be rewarded just because they spent less on a patient. Yeah, yeah, payers claim that they screen such "premium" providers for quality, but common sense suggests that they weight that provider's ability to get a patient in and out with a minimum of care more heavily than they do quality scores. It's an inherent conflict of interest, but somehow that fact gets glossed over far too often.
Periodically, doctors have fought back against the imposition of such ratings. For example, several years ago physicians in the state of New York won over then-attorney general Andrew Cuomo to their way of thinking. Cuomo demanded that state health plans adopt his doctor ranking model. The ranking model had several doctor-friendly features, including requiring that the doctor rankings were not based solely on cost and clearly identifying the degree to which any ranking was based on cost. The model also required that health plans disclose to consumers and physicians how doctors were ranked.
However, you don't see such standards in place nationwide. Payers seldom—if ever—disclose anything about how these quality ratings were developed or implemented and for the most part, providers aren’t complaining. All of the concerns that New York doctors raised seven years ago, while perhaps not forgotten, seem to be getting far too little attention.
Steering patients
As if it's not bad enough that self-interested payers are doing their own rankings on doctors, perhaps rewarding them for doing less, they are looking for ways to steer patients to these lower-cost doctors.
As Healthcare Dive reported a few days ago, UnitedHealthcare released results of the study in which it looked at how patients used its myHealthcare Cost Estimator web tool. 75% of the 425,000 UH members who used the tool chose providers who were listed as "high quality." The payer trumpeted this as evidence that properly-prepared consumers could help bring overall healthcare costs down without sacrificing quality. But of course, UH didn't dwell on the fact that the payer itself had developed the ratings, doubtless with an eye as much to price as quality.
The reality is, ratings will be done by a wide range of entities, most with a clear interest in the outcome. But I would argue that payers have such a strong, irreducible conflict of interest that they should stay out of the business of payer ratings completely. Guiding patients to the doctors who cost you less while pretending you're safeguarding their health simply should not be allowed.