If you don't take your medications or follow your doctor's advice, they are at risk of being rated in a negative fashion, in other words when it comes to the publicly listed physician ratings, you will perhaps see a drop in their ratings.  I agree this is far cry from being accurate and it can hurt a physician with pay for performance. These are just straight numbers ran and sometimes used with a generic data base of suggested results, but in many instances, the demographics used for evaluation purposes and those actual demographics in the physician's data base of patients vary - thus it will not be accurate.  I have seen offices have to go to bat for this exact purpose as you read below, i.e. penalizing a physician for not doing a mammogram on a woman who has had a mastectomy is a real obvious example stated below. 

I still think the best policy is to go to the government section and review to see if there are any reported incidents on public record and go from there, along with word of mouth recommendations from other patients who have been satisfied with their care.  All these new ratings are again far from being accurate and does put the physicians in a spot they would rather not be in, especially if the data is not correct. 

Physicians need to keep their own set of records as well to defend themselves too in this vain, there's almost no other way to substantiate and combat the issue otherwise.  If using electronic records, make sure you have a "patient registry" module that can compile all of this for you quickly, otherwise to create a report manually with paper methods, it is not only costly, but will take your staff away from the daily business of seeing patients.  Having this available in a report format with a couple clicks on the computer will definitely be an asset that will show a return on investment for any practice, when having to create a rebuttal on either published ratings, or simply going to bat to recover payments withheld, based on inaccurate information for performance ratings.  Unfortunately I don't think the ratings game is going to change any time soon, but let's hope it gets more accurate as time goes on, in the meantime, physicians, keep your own records in your own defense so you don't get wiped on the Internet with out a defense and also don't get short changed for P4P.  Try to find an EMR that does this for you, simply creating the reports based on the information you input with day to day charting.  BD

United Healthcare announced it would delay launching its program in New York, New Jersey and Connecticut after doctors complained and after New York Attorney General Andrew Cuomo threatened legal action.

One doctor fighting ratings systems is Seattle internist Michael Schiesser, who said his rating plummeted from excellent to the 12th percentile within a few months. He said initially Regence Blue Shield, an insurer in the Northwest, ranked him in its top 90th percentile of doctors and awarded him a $5,000 check.

Later, when Regence cut him from its network and patients had to pay out-of-pocket to see him or go elsewhere, he pressed to see his report. He said he discovered that he had been penalized because of errors in data-gathering.

He said Regence faulted him for failing to control diabetes in patients who did not have the disease. He said he was docked points for not performing a Pap smear on a woman who had a hysterectomy. He added that his colleague was faulted for not performing a mammogram on a woman who had undergone a double mastectomy.

Doctors critical of ratings systems say they are held accountable for whether patients exercise, take their medications or follow their prescribed regimens.

Berkenwald, the Massachusetts internist, said he was pushed from Health New England's top 10 percent of physicians into its second tier because several of his female patients did not get the mammograms or Pap smears he But Berkenwald received a top-tier rating by several other insurers participating in the state's Clinical Performance Improvement Initiative because the health plans use different cut-points for determining who falls into which tier.prescribed. 

Doctors Rated but Can't Get a Second Opinion - washingtonpost.com


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