Doctors may be able to rate health plan quality

Report cards are developing physician surveys

Physician satisfaction with health plans could become an important, new quality indicator as consumer report cards seek to incorporate the opinions of primary care physicians.

In Maryland, a comprehensive report card covering all the state’s health maintenance organizations (HMOs) will be released for the first time in October. The state requires health plans to report patient satisfaction and audited Health Plan Employer Data and Information Set (HEDIS) data.

Within two years, that requirement could expand to physician satisfaction, says John Colmers, executive director of the Maryland Health Care Access and Cost Commission in Baltimore. A similar effort is underway in Minnesota.

"It’s not to ask physicians, Do you like managed care or not?’" says Colmers. "It’s to ask questions that would help purchasers or consumers to make decisions about whether to participate in a certain plan."

For example, a survey might ask primary care physicians about the adequacy and timeliness of medical information they receive from the health plan’s laboratory or radiology partners or about the adequacy of specialty referral panel, says Colmers.

However, before the commission can add that physician component, a survey tool must undergo extensive field-testing for validity and reliability, Colmers says. There is no accepted physician satisfaction survey of health plan performance.

"The empirical questions we have are quite fundamental," says Colmers. "Are physicians able to distinguish among the plans that they’re working with?"

The Medical and Chirurgical Faculty of Maryland, the state’s medical society, is highly supportive of both the initial report card and the possible expansion, says deputy executive director Margaret Burri, MA.

Link between quality and docs’ happiness

"We think there’s a correlation between physician happiness with an HMO and the quality of the HMO," she says.

When Maryland publishes its report card in October, it will be the most extensive in the country. Maryland was the first state to mandate participation by all HMOs with at least $1 million in member premiums.

Fifteen HMO’s provided audited data on 17 HEDIS measures and patient satisfaction. The commission contracted with the National Committee for Quality Assurance in Washington, DC, which developed HEDIS and accredits health plans, to provide technical assistance. The Medstat Group in Ann Arbor, MI, provided auditing services.

The report card will be released in three formats: a 20-page summary geared toward consumers; a detailed report for purchasers and health plans; and an industry-focused report for legislators and policy-makers.

Even without the physician satisfaction survey, physicians can gain much useful information from the report card, notes Alan Hoffman, MHS, chief of HMO Quality and Performance for the commission.

"Physician groups can use it when they decide who to contract with," he says.