Are Physician Rating Systems Nonsense?

February 6, 2018
Jennifer Frank, MD

This doctor is fed up with the feedback she receives from her insurance company regarding her performance.

Today was the closest I've come in a long time to hanging up my corporate stethoscope and entering the field of direct primary care. There is tremendous appeal to me in simply providing medical care for a reasonable fee without going through insurance or having to jump through the endless hoops Medicare requires. However, there are many reasons holding me back, not the least of which is the security of being an employed physician. However, two events pushed me to the edge this afternoon.


The first is a "premium quality" rating by one of our insurers. Through a complex formula which may involve Newtonian physics, physicians are rated into tiers – a reflection of their quality and cost of care. Not only did I not qualify for tier 1, I didn't qualify for tier 2. I was put in the category of "did not meet quality care and is essentially a quack physician" (I added that last part for emphasis).


This perplexes me. While I can accept that I may not be among the best physicians in terms of the cost of care/quality mix, I have to protest that I'm in the low quality category. So, I logged onto the insurer's website to investigate my "patient care opportunities." Since I didn't know my organization's tax ID number, I couldn't complete my log in. Then the website wouldn't even let me try to log in anymore. I called the phone number provided. I spoke with a representative who told me, helpfully, that I needed to enter the organization's tax ID number. I found the number. I entered it. Things went haywire again. I gave up. The system has beat me.


No one wants to be told that they are performing sub-par. I suspect that my ranking may be an error based on the fact that, as medical director for our urgent care, claims are submitted under my name thereby making my cost of care seem quite high. However, the lack of transparency of how the math is done, the extreme difficulty in getting information, and really, the idea that the entirety of my medical practice can be fit into a tier is offensive.


The second insult came when we were informed of a new requirement by another health plan that our physicians would need to go through an extensive process for opioid prescribing that involved completing their own online training (I've already completed more than the requirement for my state license for opioid prescribing), obtaining all past medical records (yes, this is good medical practice but can be challenging in reality), preferentially prescribing at specific pharmacies, and so on.


Our organization has a thought-out process and policy for controlled substance prescribing. We practice in a state with robust regulations governing controlled substance prescribing. This is an additional layer of complexity added to an already high-risk and complex process.
I am all for safe opioid prescribing, but sometimes these types of regulations and hoop-jumping result in physicians refusing to prescribe. Those who continue to prescribe will end up with an increasingly burdensome workload as patients transfer care to them.


Both of these initiatives are grounded in good intentions. The care we provide should be evaluated for both quality and cost. Opioids should be prescribed responsibly and safely. However, physicians are getting burned out or are already so.


One of the main contributors is when our work becomes more difficult to complete while we are simultaneously scrutinized against a wide range of rating systems and scales that may fail to convey the entire picture.


I may be ready to turn in my NPI number and start bartering my services for chickens and free oil changes.