HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Thursday, February 7, 2008

Rating Your Doctor: Cost v. Quality of Care

The Wall Street Journal's Health Blog reports on Tennessee BlueCross BlueShield's adoption of doctor rating.  Jacob Goldstein reports,

The debate over insurers rating doctors encapsulates a lot of what people are fighting over in health care these days: Who should have access to what information, how to determine quality of care, and the roles insurers and doctors should play. But even as the debate continues, it’s clear that consumers will get more information about their doctors, and insurers are starting to dish it out.

The latest example comes courtesy of  the Nashville Tennessean, which reports today that BlueCross BlueShield of Tennessee, the state’s largest insurer, will soon start rating doctors based on whether patients get appropriate tests and treatments. The insurer’s private customers will also be able to get info on how much doctors charge.

The insurer will stop short of recommending particular doctors. And, the article reports, it will follow the rating model established by negotiations between the New York AG’s office and several big insurers. One key element is disclosing the criteria that go into rating doctors, and allowing doctors to appeal their ratings.

Docs have argued that insurers have an incentive to send patients to the cheapest — but not necessarily the best — doctors.  Dr. William Edwards, a vascular surgeon who served on an advisory panel to the Blues on the ratings, said that doctors who see sicker patients could be at a disadvantage because their costs would be higher. “If you publish that data, you run the risk that those doctors could become averse to taking on those risky patients because it makes them look bad,” he told the Tennessean. . . . .

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