To the editor:
A letter recently published in AAFP News Now, "Claims-Filed Data No True Indicator of Care Quality," resonates with me as I've had a similar experience.
I participate in an HMO that uses claims-filed data to measure performance in a number of areas including flu shots and gynecologic screenings.
I fell below standard for flu shots despite the fact that nearly all of my patients received a flu shot. The problem: Some patients got their shots at places more convenient for them, such as the VA hospital or the supermarket.
Despite the fact that I documented the patients' actions at the plan's request, I fell below standard. In the plan's eyes, if I don't deliver the service, it doesn't count.
Another example: My sample size for eligible gynecologic screenings was low, and then enough women declined (I documented three) that I fell below standard. Again, it didn't matter that I recommended the screening.
Not only is my quality payment significantly reduced, the distorted information is published for the public on the plan's Web site.
I am furious because I put in the effort to provide quality care and was penalized solely because of claims-filed data.
Mark Powell, M.D.
Wind Gap, Pa.
