Several insurance companies have tried to share quality information with enrollees by developing “star” systems to rank physicians. While star rankings may be a good way to pick a movie or restaurant, the ACR feels this system may be too simple to serve as a tool for identifying quality healthcare. Consumers need quality information, and need to know the true costs of medical services so they can make informed decisions about their healthcare. This idea is reflected in an executive order President Bush signed in August 2006 requiring government agencies to work with the private sector to gather and share data on the quality and cost of healthcare.
Star-based ranking systems employed by insurance companies, such as United Health Care, PacifiCare and CIGNA, are designed to provide consumers with an effective tool to make better informed healthcare decisions and thereby improve the quality and cost efficiency of healthcare. While the ACR agrees that improved quality of care is a laudable goal—and has launched a comprehensive effort to develop measures and performance indicators that make sense from a rheumatologist’s standpoint—the ACR is concerned that the current star-based ranking system could have the unintended negative consequence of misleading patients.
The ACR believes that in order for the insurance companies’ star-based physician ranking systems to accurately provide better information to consumers, they must clearly delineate which stars are awarded based on quality measures and which are awarded based on cost efficiency. Otherwise, the system could lead patients to choose a provider based primarily on the number of stars awarded, without understanding what each star represents. The ACR believes this is not the intent of President Bush’s executive order on healthcare transparency.
To address this issue, the ACR sent a letter to insurance companies implementing star-based physician rankings and asked for more transparency in their ranking systems. The letter highlighted President Bush’s executive order and expressed the ACR’s concern that the star-based ranking system could be misleading to some patients. The ACR also requested that programs include a clear explanation of the difference between stars awarded for demonstrated quality of care versus stars awarded for cost efficiency or other criteria in order to give patients the opportunity to make truly better informed healthcare decisions.
The ACR will continue to monitor this issue and work with insurance companies that are using the star-based ranking system. Please contact Antanya Chung, senior practice management specialist or (404) 633-3777, ext. 818, or your Regional Advisory Council representative if you learn of any insurance companies utilizing a star-based physician ranking system.
ONLINE RESOURCES
Coding Advice for State and Local Societies
Due to last year’s success, ACR’s coding specialists will be visiting state and local rheumatology societies to present coding tips again in 2007.
Last year, ACR’s two certified professional coders, Antanya Chung, CPC, and Melesia Collins, CPC, visited 15 state and local societies. Their coding presentations included information on documentation, consultation codes, Modifiers -25 and -59, drug administration codes, new drugs available, denials and appeals, and compliance. Each presentation was eligible for 1 CME credit.
If your state or local society wants to schedule a coding presentation for an upcoming meeting of your membership, please contact Melesia Collins, CPC, at (404) 633-3777, ext. 820. Dates fill up quickly, so please contact us soon to schedule your presentation.
