Patient Charter Signals Change in Physician Performance Reporting

Some of the largest health insurance plans in the United States have agreed to adhere to a national set of principles for collecting and reporting physician performance measurements to consumers.

The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs (3-page PDF; About PDFs) was launched under the auspices of the Consumer-Purchaser Disclosure Project. It is endorsed by some of America's leading business, consumer, health insurance and physician groups, who agree that the accord is an important step toward patient-centered health care reform.

The AAFP joined the AMA, the American College of Physicians, the American College of Cardiology and the American College of Surgeons in endorsing the charter.

Academy EVP Douglas Henley, M.D., said the patient charter is consistent with AAFP policy regarding physician performance measurement and public reporting. He noted that the charter addresses an issue of extreme importance to physicians -- namely, that physicians have the opportunity to examine their quality-related information and correct any errors they find before the information is released to the public.

The AAFP is pleased that the patient charter calls for performance measures that are based on the best available evidence and align with national standards, including those endorsed by the National Quality Forum, said Henley. "Importantly, this charter calls for the consistent use of a defined set of performance measures for family medicine and primary care, thus calling attention to the burden of measure reporting for our members," he added.

The agreement also addresses the issue of transparency. Henley noted that health plans that accept the terms of the charter would consent to an outside review of the processes and methodology they use to create, aggregate and report physician data. "An independent audit of health plan efforts on public reporting of physician data will help ensure that physicians and their patients clearly understand the criteria and the methodology, and it will eliminate the 'black box' processes that currently create confusion and misunderstanding," said Henley.

Some of the nation's largest health plans, including Aetna, CIGNA, UnitedHealthcare and WellPoint, have endorsed the patient charter. Karen Ignagni, president and CEO of America's Health Insurance Plans, promised that a full spectrum of health plans across the country would support the charter and its underlying concepts.

National business groups endorsing the charter include the AARP, the Leapfrog Group, the AFL-CIO, the National Business Coalition on Health and the Pacific Business Group on Health, or PBGH.

Peter Lee, J.D., executive director for national health policy of PBGH and co-chair of the Consumer-Purchaser Disclosure Project, hosted a telephone media call on April 1 to announce the project. According to him, during the past five years, consumers have been exposed to an increasing flood of physician measurement information. The quest for physician information has been driven in large part by health plans and embraced by the public. But concerns about consistency and fairness of measurement criteria across health plans and state lines have kept physicians on edge, Lee said.

The patient charter "is an agreement to have a national solution," said Lee. Its wide scope will "touch virtually every American and every doctor in America." The charter will move from concept to reality within the next six months, he predicted.

Debra Ness, president of the National Partnership for Women and Families and co-chair of the project, called the patient charter "a big win for consumers," because physician measurement would help drive health care quality. The charter will "ensure that consumers, at the end of the day, have information that is reliable and trustworthy," she said during the media call.

During the media call, AMA President-elect Nancy Nielsen, M.D., said the patient charter was a "logical extension" of agreements reached in November 2007 between New York Attorney General Andrew Cuomo and the major health insurance companies in New York State.

In those agreements, CIGNA, Aetna, Empire BlueCross BlueShield and UnitedHealthcare all agreed to restructure their physician ranking programs after Cuomo accused the plans of steering patients to the cheapest, but not necessarily the best, doctors.

Physicians have seen "inaccurate and misleading information" that has caused confusion and chaos for patients and physicians, said Nielsen of health plans' so-called steering and tiering programs. The patient charter "goes a long way toward resolving some of the past problems with methodology," she noted.

"It's not enough to be transparent," Nielsen continued, adding that what is needed is valid and reliable information that is not based on cost alone. With the right information at their fingertips, she said, "consumers are smart enough to make decisions on their own; they don't need a tiered and narrowed (health plan) network."