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Fam Pract Manag. 2005;12(3):37-38

Physicians’ quality report cards to go public

By summer, physicians in Washington who contract with the state’s second-largest insurer, Regence Blue Shield, will find individual reports of their quality available on the Internet for patients to access, the Jan. 14 Puget Sound Business Journal reports. While other insurers have published ratings of medical groups as a whole, Regence will be the first to post ratings of individual physicians.

Physicians will be scored on 33 measures related to diabetes testing, mammography, immunizations and cervical cancer screening. The reports are intended to assist patients in selecting a physician and to encourage physicians to improve care, which the health plan argues will result in lower health care costs.

Some physicians worry that the measurements could be invalid or misinterpreted and are concerned about losing current and prospective patients. Regence medical director Mark Rattray, MD, acknowledged that the rating system is not a perfect science but said it is a necessary first step toward improving health care quality.

A uniform yardstick

In a related story, a coalition of the nation’s leading consumer, employer and labor organizations is working to promote rapid, industry-wide adoption of standardized performance measures to help patients compare the relative quality and cost of care provided by the nation’s hospitals, physicians and health care systems. The Consumer-Purchaser Disclosure Project includes such groups as the AARP, AFL-CIO, Association of American Medical Colleges, Bridges to Excellence and CIGNA.

The coalition is calling for the use of scientifically-valid performance measures endorsed by the National Quality Forum and coordinated data collection to ease the burden for providers. It hopes to give all Americans access to publicly reported health care performance information by Jan. 1, 2007.

Medicare pay-for-performance demo under way

Ten large medical groups have been selected to participate in three-year demonstration project to test performance-based reimbursement under the Medicare program. Groups participating in the program will continue to be reimbursed under the Medicare fee schedule for services provided to beneficiaries. In addition, they will be eligible for additional payments based on their performance on 32 measures related to chronic illness care and preventive services and on the level of savings they achieve. Annual savings targets will be set for each group, with Medicare retaining 20 percent of any savings and the medical group earning 80 percent of any savings. The project will begin in April.

Health care professionals unlikely to address colleagues’ errors

Physicians, nurses and other health care professionals rarely confront their colleagues about medical errors or other workplace problems, according to a study sponsored by the American Association of Critical Care Nurses and VitalSmarts. Researchers interviewed and observed more than 1,700 health care professionals – mostly nurses – at 13 hospitals nationwide. Respondents cited a number of reasons for failure to confront colleagues about negative behaviors, including lack of confidence that it will help, lack of time and fear of retaliation. However, those who had confronted their colleagues about errors or negative behaviors said their efforts led to improved patient care and job satisfaction.

The study concludes that health care organizations must build environments that breed good communication and collaboration among staff if they hope to improve patient safety.

“Too often, improving workplace communication is seen as a ‘soft’ issue – the truth is we must build environments that support and demand greater candor among staff if we are to make a demonstrable impact on patient safety,” said Kathy McCauley, RN, PhD, president of AACN.

Study highlights:

  • 84 percent of physicians and 62 percent of other health care professionals said they have observed colleagues taking shortcuts that could endanger patients;

  • 88 percent of physicians and 48 percent of other health care professionals said they work with someone who shows poor clinical judgment;

  • About 20 percent of physicians said they have observed patients injured by such behaviors;

  • Fewer than 10 percent of respondents said they have addressed colleagues about negative behaviors.

Physicians sue health plan over fee reduction

Following plans by Blue Cross Blue Shield of Michigan to reduce physicians’ fees in order to help reduce health care costs for several U.S. automakers, the Michigan State Medical Society and the Michigan Osteopathic Association have filed a lawsuit against the insurer. The groups, representing 19,000 physicians, argue that the health plan has no contractual right to limit physicians’ fees unilaterally and is engaged in price fixing. The insurer contends it is merely extending discounts to United Auto Workers that it currently extends to other groups, such as state employees.

At press time, the physicians were seeking a preliminary injunction barring Blue Cross from terminating their contracts over refusal to accept the new fees. If doctors are dropped from the health plan, thousands of patients could be looking for new doctors.

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