Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Does your insurance company know who the good doctors/surgeons are?

17.09.2010
New study finds that physician ratings do not help consumer decision-making

Several health plans have introduced physician rating systems to offer consumers more information when choosing their doctors. However, a recent study presented in the September issue of the Journal of Bone and Joint Surgery (JBJS) reveals that physician-tiering guidelines and results are not consistent across insurance companies, do not fully define quality; and could confuse consumers.

Since affordable and more accessible health care is a critical national challenge, the use of rating systems will increase as one response to rising costs. Doctors receive notices from insurance companies about their ratings, although they do not fully understand how their tier was determined. When patients receive letters from insurers and see that their doctors are not in a top tier, their reactions may range from disappointment to confusion. This study is the first to analyze tiering system data as it applies in a specific setting.

"We examined data on 615 orthopaedic surgeons who had been accepted in one or more health plans in Massachusetts," explains one of the authors, orthopaedic surgeon Timothy Bhattacharyya, MD, Head, Clinical Investigative and Orthopaedic Surgery Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). "Tiering ranks physicians on the basis of cost efficiency and adherence to performance quality benchmarks. Thus, a higher physician rating could lead to lower co-pays and out-of-pocket costs for patients."

... more about:
»AAOS »Orthopaedic »Prostate Surgery

This study also reveals concerns that should be addressed:

Study analysis showed that board certification, Medicaid acceptance, and practice in a suburban location were independent factors associated with a physician ranking in the top tier. However, more years in practice or fewer malpractice claims, important indicators of quality, did not influence or factor into tier rating. Dr. Bhattacharyya and his co-authors suggest that tiering data deserves more exploration and a clearer definition of quality.

Insurance companies did not agree on physician inclusion in top tier. Since ratings are not consistent from one insurance company to another, a physician is often rated differently from one plan to another.

Patients need more information about physician tiering. While health plans display a physician's tier in online and printed directories, explanation of stratification methodology and its relation to quality of care is limited. Currently, for example, there is no evidence to suggest that physicians ranked in a second tier provide lower quality care.

The authors note that their study has limitations. Data was examined for one specialty, orthopaedics, and in one state, and may not be applicable to other medical specialties or geographical areas. The lack of agreement between health plans may be the result of measuring different aspects of healthcare quality. A "gold-standard" consensus could serve as a benchmark and provide consistency across plans.

What should consumers do if they check a physician and discover that he/she is not in the top tier? Dr. Bhattacharyya explains that:

Your physician's rating may change from one plan to another, so compare his/her rating with another plan.

When checking on a physician, ask about board certification and experience in this medical area or procedure. Seek referrals from people you trust, such as your doctor or someone who has had the same procedure or condition.

Information about methodology and its relationship to quality of care is limited. Because this issue can misrepresent doctors and confuse patients, we should seek a universal definition of quality.

About the American Academy of Orthopaedic Surgeons (AAOS) www.aaos.org

About the JBJS
www.jbjs.org
Fan the AAOS on Facebook.com/AAOS1 and follow us on Twitter.com/AAOS1

Lauren Pearson | EurekAlert!
Further information:
http://www.aaos.org

Further reports about: AAOS Orthopaedic Prostate Surgery

More articles from Studies and Analyses:

nachricht Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland

nachricht Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Argon is not the 'dope' for metallic hydrogen

24.03.2017 | Materials Sciences

Astronomers find unexpected, dust-obscured star formation in distant galaxy

24.03.2017 | Physics and Astronomy

Gravitational wave kicks monster black hole out of galactic core

24.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>