On April 1, 2008, a broad coalition of leading physician organizations, health insurers, consumer and labor organizations, and employer associations reached a major agreement to support a national set of standards to measure physician performance.  The Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs (the Patient Charter), developed by the Consumer-Purchaser Disclosure Project, will be the first national effort to standardize and improve physician-rating programs.  Currently, most insurers rate physicians on the insurers' own web sites, using their own performance measurements, but some physician groups have argued that the insurers' performance measurements have focused too much on cost rather than on the quality of care that the physicians provide.  

A Decade In The Making

The Patient Charter follows more than 10 years of various ranking programs, physician scorecards, and performance designation programs attempting to rank physicians.  It represents a compromise between physician groups and insurers.  Several previous ranking efforts have been controversial. 

For example, BlueCross BlueShield of Tennessee (BCBS) planned to start rating physicians in April 2008, based on how much the physicians charged and whether patients received the correct tests and treatments required for certain conditions.  In March 2008, however, BCBS delayed the planned physician-rating program after the Tennessee Medical Association, the state's largest physicians' group, questioned the program following complaints about inaccuracies and doubts about the rating methods.   

Another effort in New York took a slightly different approach.  In 2007, New York Attorney General Andrew Cuomo ordered an investigation of the physician rankings of Aetna and Cigna in New York state, warning that the rankings were confusing for consumers and potentially deceptive.  Cuomo eventually reached an agreement with several major insurers by arranging for them to adopt a Doctor Ranking Model Code, which uses established national standards to measure physicians' quality of care, fully discloses how the rankings are designed and clearly identifies how cost is used to determine a performance score.  The Patient Charter builds on New York's Doctor Ranking Model Code.  

National Standards Focus On Quality

The Consumer-Purchaser Disclosure Project is an initiative by a group of employer, consumer and labor organizations to improve publicly available healthcare industry performance data.  The goal of the Patient Charter is to replace the varying physician performance evaluation systems with a set of national standards.  Although not yet finalized, some of the Patient Charter's key provisions include:

  • Separation of care quality rankings from cost-efficiency measurements
  • Full disclosure by insurers of what methods they use to rate doctors
  • Prior notice to physicians before they are ranked and a dispute process allowing them to challenge results they consider inaccurate  

Under the standards of the Patient Charter, physicians are not ranked based on fees alone, and there is a focus on greater transparency and consistency in performance measures.  Participating insurers also agree to have their ranking systems reviewed by independent parties. The supporters of the Patient Charter include some of the largest U.S. health insurers such as Aetna, UnitedHealthcare, Cigna, WellPoint, and the health insurance industry's lobbying body, America's Health Insurance Plans.  The Patient Charter is also endorsed by the American Medical Association, the American College of Cardiology, the American College of Physicians, and the American College of Surgeons, among other physician organizations, and by the AARP, AFL-CIO, General Electric, General Motors, and other consumer, labor, employer and quality organizations.  

The general framework for the Patient Charter has been established, but the details are not yet finalized and are still subject to fine-tuning.  The Consumer-Purchaser Disclosure Project has not yet released information regarding when the Patient Charter will be complete, but more information can be found at this link.

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