Managed Care With a Face-Lift?

Report cards may cause doctors to turn away the sickest patients

Here in one of the HMO industry's stronghold states, we've heard a lot in recent months about health insurers' latest gambit for delivering "value" and "efficiency" to ratepayers--er, members. The latest thought is that there are cost savings to be realized by gathering data that will identify the best doctors, and then steering patients their way. The catch, of course, being that your insurance company's idea of a great doctor may not be yours.

The Los Angeles Times this week highlights another risk of the doctor-rating gambits: Physicians could turn away the sickest patients, whose poor chances for successful treatment could drag down their personal stats.

Last week, researchers at the University of Michigan released a study of New York's pioneering public reporting system, which for several years has tracked how well doctors perform two major types of heart surgeries.

The study, which included more than 80,000 patients from both states, found that doctors in Michigan were more likely than their counterparts in New York to perform angioplasties on very sick patients.

Because Michigan has no physician report card program, the researchers concluded that New York doctors may be shying away from treating their sickest patients out of concern that a poor outcome could adversely affect their grades.

A separate survey released in the Archives of Internal Medicine this year found that nearly eight of 10 New York cardiologists said public reporting of data made them less likely to treat severely ill patients.

Of course, no amount of efficiency measuring, consumer satisfaction surveying, and other free-market gimmickry will make a whit of difference until we are willing to concede that the health insurance industry is in fact an industry.

Still, meaningful or not, ratings are headed our way. Accordingly, you might want to read the rest of the story here.

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