Delegates Defeat Measure Calling for AAFP to Oppose Performance Reporting
By Cindy Borgmeyer
• San Diego
9/19/2008
Call it what you like -- physician profiling, ranking or tiering -- family physicians are leery of health insurers' increasingly prevalent practice of measuring and sometimes publicly reporting on physicians' performance. Judging from some of the testimony offered during a hearing of the Reference Committee on Practice Enhancement, which considered this topic at the 2008 Congress of Delegates on Sept. 15, they have reason to be.
Erica Swegler, M.D., an alternate delegate from Keller, Texas, testifies during the 2008 Congress of Delegates about her practice's experience with an insurer-based physician performance measurement program.
Listen to a brief interview (2:38-minute MP3 file; About Downloading) with Texas alternate delegate Erica Swegler, M.D., on physician ranking programs.
Still, most of those who testified on a resolution calling for the Academy to take a stand against physician ranking acknowledged that the practice is almost certainly here to stay. From that perspective, they said, the relevant question becomes: How should this ranking be conducted, and what steps can health plans take to assure physicians that they're being treated fairly?
Texas alternate delegate Erica Swegler, M.D., of Keller, was one of those who testified that family physicians should support the concept of physician performance measurement, with the goal of collaborating with insurers on how the findings are used.
"There are really three issues," Swegler said in an interview with AAFP News Now. "The data has to be transparent; it has to be based upon not pure cost or economic credentialing but, really, on cost-effectiveness, which would include, by definition, a quality piece; and it would also have to be potentially aggregate data so that the numbers of patients involved would actually be significant when you're looking at any individual physician's practice."
One problem Swegler said she's run across in her own practice is that despite earning a top-quality rating from one insurer she deals with, the company deselected her practice from its low-cost network at one point because of a slightly higher-than-expected risk-adjusted cost of office-based care. That was despite the fact that the insurer reported that the practice had racked up major savings in all other areas of care.
Swegler's experience -- although later rectified -- serves to illustrate how things shouldn't work with such systems. It flies in the face of logic, according to others who testified, that enhancing quality would do anything but lower costs.
"If you're showing good quality, you're showing less expensive care, too," said Missouri alternate delegate Larry Rues, M.D., of Kansas City. "They just go hand in hand."
There were a handful of naysayers who spoke up during the reference committee, voicing their concerns that reducing costs is the true motivator behind such programs -- not achieving higher-quality care.
"Whenever I hear that patients are clamoring to know how their physicians' are ranked, it seems to come from financial motivations," said Idaho delegate William Woodhouse, M.D., of Pocatello. "I don't want to give insurers an opportunity to rank 50 percent of physicians as substandard.
"We shouldn't bring the rope to our own hanging."
In the end, delegates agreed with the recommendation of the practice enhancement reference committee, defeating the resolution. According to its report, the reference committee acknowledged the collaborative work the AAFP already has done with insurers on this issue and concluded it was neither practical nor in the Academy's or members' best interest to flatly oppose physician performance reporting.
Texas alternate delegate Erica Swegler, M.D., of Keller, was one of those who testified that family physicians should support the concept of physician performance measurement, with the goal of collaborating with insurers on how the findings are used.
"There are really three issues," Swegler said in an interview with AAFP News Now. "The data has to be transparent; it has to be based upon not pure cost or economic credentialing but, really, on cost-effectiveness, which would include, by definition, a quality piece; and it would also have to be potentially aggregate data so that the numbers of patients involved would actually be significant when you're looking at any individual physician's practice."
One problem Swegler said she's run across in her own practice is that despite earning a top-quality rating from one insurer she deals with, the company deselected her practice from its low-cost network at one point because of a slightly higher-than-expected risk-adjusted cost of office-based care. That was despite the fact that the insurer reported that the practice had racked up major savings in all other areas of care.
Swegler's experience -- although later rectified -- serves to illustrate how things shouldn't work with such systems. It flies in the face of logic, according to others who testified, that enhancing quality would do anything but lower costs.
"If you're showing good quality, you're showing less expensive care, too," said Missouri alternate delegate Larry Rues, M.D., of Kansas City. "They just go hand in hand."
There were a handful of naysayers who spoke up during the reference committee, voicing their concerns that reducing costs is the true motivator behind such programs -- not achieving higher-quality care.
"Whenever I hear that patients are clamoring to know how their physicians' are ranked, it seems to come from financial motivations," said Idaho delegate William Woodhouse, M.D., of Pocatello. "I don't want to give insurers an opportunity to rank 50 percent of physicians as substandard.
"We shouldn't bring the rope to our own hanging."
In the end, delegates agreed with the recommendation of the practice enhancement reference committee, defeating the resolution. According to its report, the reference committee acknowledged the collaborative work the AAFP already has done with insurers on this issue and concluded it was neither practical nor in the Academy's or members' best interest to flatly oppose physician performance reporting.
