[MMA News Now, July 21, 2010] – In response to new evidence that patients are receiving inaccurate physician profiles from health insurers, the American Medical Association (AMA) delivered letters to the nation’s largest health insurance companies Monday asking for immediate action to improve the accuracy, reliability and transparency of physician ratings.

The letters called on each health insurer to publicly document the accuracy of their physician cost profiles by submitting the programs for external review by unbiased, qualified experts.

“Patients should always be able to trust that insurers are providing accurate and reliable information on physicians,” said AMA President Cecil B. Wilson, M.D. “Studies show that economic evaluations of individual physicians are so unreliable that they are more often wrong than right.”

A series of studies recently conducted by researchers at RAND Corporation confirm the AMA’s longstanding contention that serious flaws exist in health insurer programs that attempt to rate individual physicians based on economic criteria. One RAND study shows that physician ratings conducted by health insurers can be wrong up to two-thirds of the time for some groups of physicians. Under the best circumstances, insurers misclassified about one-fourth of all physicians. This and the other studies call into question the use of cost-profiling tools to control health care spending and provide the public with information.

“Transparent, accurate information is critical when selecting a physician,” said Wilson. “Patients deserve to know that insurers are offering physician ratings that have a high risk of error and should not be the sole basis for selecting a physician.”

The Minnesota Medical Association shares the AMA's concerns but decided not to sign the letter since it didn’t fit with Minnesota’s situation.

MMA CEO Robert Meiches, M.D., told the Star Tribune that for one thing, Minnesota already measures physicians for cost and quality by group, not individually. Secondly, the MMA has been working with the state on a way to collectively analyze all commercial insurance claims to come up with a single set of measurements for physician groups and clinics.

“We are not opposed to what the AMA is trying to do. We agree with many of their concerns and the data they cited, but the letter just didn’t fit with Minnesota’s current circumstances,” Meiches told MMA News Now.

The MMA has been working with insurers and the state government to improve local physician tiering and ranking efforts for several years.

In 2006, the MMA examined the different insurer products that tiered physician groups and encouraged them to improve them by increasing their focus on quality. During the past legislative session, the MMA worked to introduce and pass a bill that includes a new requirement that the state’s physician peer grouping data scheduled to be released this fall must meet standards for reliability and validity.