To the editor:
Claims-filed data, as used by the UnitedHealthcare performance program described in "Academy Blasts Insurer's Performance Program," is a totally inappropriate way to determine quality of care.
The physician can advise a patient to get her cholesterol level checked, but if the patient doesn't follow through, no claim is filed. It looks like the physician isn't practicing good medicine -- when the real problem is patient noncompliance.
Likewise, if laboratory staff registering a Medicare patient are unsure whether the diagnosis is valid for the labs ordered, they hand the patient an Advance Beneficiary Notice. I've had several Medicare patients refuse to sign the ABN and thus have not had the labs drawn I had ordered.
Once again, no claim is filed and it looks like I'm not providing quality care when, in fact, the problem is with the lab.
Claims-filed data only indicate a billable procedure was done, not whether a physician is providing -- or, in the case of noncompliant patients, attempting to provide -- care that meets or exceeds care standards and/or national guidelines.
Deborah Wilson, M.D., M.P.A.
Columbus, Ohio
