The bright light of practice evaluation is making more than a few physicians uncomfortable; these docs have decided that it is somehow unfair for insurers to suggest members go to specific physicians.
So, like all red-blooded Americans, the docs are suing the insurers.
While the docs in question may think they are standing up for their rights, their actions look more childish than professional from here.
The protestations concern a move by CIGNA and UnitedHealthcare to reduce copays for members seeing certain specialists. The motivation for CIGNA and UHC is clear; lower costs and hopefully better outcomes.
But the docs not on the ‘A List’ are screaming “unfair”, accusing the health plans of unfair discrimination on the basis of faulty data. The group suing the health plans claims that they are only using claims data to evaluate providers, and this somehow is unfair and biased and does not provide a complete picture.
While claims data may not provide a ‘complete picture’, it certainly provides a lot of information that can be used to evaluate certain practice patterns and the effectiveness of treatment and follow up. ‘Claims data’ typically includes patient demographics, primary and other diagnosis codes, procedure codes, and medical documents – treatment notes and reports and the like. There’s a lot of solid, useful data there that can paint a picture that if not complete is certainly a lot more than a sketch.
There are two closely related issues here – the providers’ refusal to understand that these payers are well within their rights to encourage their members to use certain docs, and the arrogance that seems to be behind the providers’ behavior.
What does this mean for you?
Remember the golden rule – s/he who has the gold rules.