AMA gets its comeuppance; are trashed by BigInsurance <LOL>
Mort Zuckerman
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Subject: AMA gets its comeuppance; are trashed by BigInsurance <LOL>
Date: Jul 20, 2010 9:40 AM
ARTICLE BELOW
=============================
ROTFLMAO. That's what they get
for not fighting *for* patients, not
fighting *AGAINST* managed care, letting
insurance companies interfere with
"diagnosis and treatment" "guidelines."
Like Kaiser-Permanente at New York
Medical College. Physically. Still
there. "Training" MDs.
The only times the AMA or any doctors'
groups ever sued insurers was over THEIR
OWN REIMBURSEMENTS, but never over the
fact that BigInsurance hijacked "Lyme
disease" and all the related TLR2-agonist
immune suppression outcomes: Cancer
MS, Lupus, ALS, etc., that now, !, no
one disputes.
Ha, ha, ha. The AMA don't like it
when BigInsurance tortures THEM, but
when BigInsurance tortures us'n sick
people?
Not a single Y-gonad cell to be
detected among them.
BigInsurance is justified in rating
all of MD-America to be "MORONS." That's
the grade we gave them, too.
KMDickson
http://www.relapsingfever.org
===============================
courant.com/health/hc-doctor-insurance-
letter-0720-20100719,0,5361241.story
Courant.com
Doctors Attack Insurance Company Grading Systems
By MATTHEW STURDEVANT, mstur...@courant.com
10:21 PM EDT, July 19, 2010
Advertisement
As health insurers' grading systems for doctors gain popularity, the
nation's largest physician group is crying foul, saying the insurers
are giving information to patients based on inaccurate and unreliable
data.
The grades attempt to gauge both quality of care and cost — typically
in simple presentations using stars. Aetna, for example, uses a single
blue star to show a doctor has the company's preferred "Aexcel"
designation which incorporates quality as well as cost measures.
The American Medical Association sent a letter to health insurers
Monday asking for better accuracy and reliability in grading
physicians. The doctors' group said that health insurers' current
systems are wrong 25 percent to 66 percent of the time, according to
research by the RAND Corporation that was partly funded by the
association.
The letter was signed by medical associations in 47 states, including
the Connecticut State Medical Society. AMA President Cecil Wilson said
a tiered system can destroy provider-patient relationships if a
provider is in the lowest tier.
"If you've done that with inaccurate data, which is flawed, that's a
horrible thing, and it will adversely affect care," Wilson said in an
interview. "In addition, of course, that's the kind of thing that's
shared in the community and reputations are destroyed as a result."
Health insurers including Aetna, CIGNA Corp., UnitedHealth and
WellPoint have used grading systems for the past four to six years.
ConnectiCare does not use a grading system.
Several insurers and their largest trade group said Monday they need
the grading systems to keep costs down and satisfy demands by members
for quality measures of doctors. The industry is open to finding ways
to improve the systems, and has already reached out to doctors in
creating them, officials at the companies and the trade group all said
in interviews.
Monday's volleys were part of a broader, contentious debate between
doctors and insurers. The groups, both politically powerful, are
fundamentally at odds over who should decide on the availability and
scope of medical care.
The doctors' groups say they are not trying to halt the use of grading
systems — some of which are available directly to patients through
websites such as http://www.healthgrades.com. Rather, the doctors say,
they want a stronger voice in creating the insurance company
measurements. Under federal health care reform enacted this year,
grading systems for doctors must be in place by 2013.
"I think it's always a good thing that you take a look at programs
that are supposed to be increasing the quality of care for people,"
said Ken Ferrucci, vice president of government affairs at the
Connecticut State Medical Society. But he added, "Just make sure that
they're doing what they're supposed to do."
Exactly how regularly patients use the information isn't clear,
although both doctors and insurers believe the lists of providers is
commonly used. Insurers are quick to add that patients should pick a
provider based on personal choice, and that the ratings should be just
one factor in the decision.
The medical association says the current methods for rating doctors
are flawed and shouldn't be used. The RAND study found that the
underlying data is subjective and therefore can lead to different
conclusions when applied multiple times to any one doctor. The study
also found that factors unrelated to quality and efficiency, such as
different types of patient populations, can affect the grading.
Insurers and the trade organization America's Health Insurance Plans
said doctors played key roles in creating the systems. CIGNA relies on
the National Committee for Quality Assurance to set standards, said
Dick Salmon, the company's national medical director for performance
measurement and improvement.
"There were physicians participating on the advisory group that
developed the standards, and there are physicians on their board of
directors that ultimately endorsed the standards," Salmon said.
Some consumer groups have endorsed a so-called Patient Charter, which
promotes fairness and consistency in the grading systems used by
insurers. "Our Blue Precision physician performance program is in
alignment with the principles set forth in the Patient Charter," said
Sarah Yeager, Connecticut spokeswoman for Anthem Blue Cross & Blue
Shield.
At Aetna, spokesman Walter Cherniak Jr. said, "Our customers are
telling us that affordability of health care is key, and they are
specifically looking for lower cost providers. We see a role here for
the AMA in helping determine how to accurately measure providers on
costs, and we believe the industry would welcome their ideas and
recommendations."
KMDickson