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News of the Day ... In Perspective

8/10/2007

Doctors’ reputations harmed by inaccurate rating system

Data from growing electronic data warehouses are being crunched to assess doctors’ performances—with no second opinions available.

While claiming that “our focus is really on transparency,” UnitedHealth Group was profiling physicians for 18 months without their knowledge.

Seattle internist Michael Schiesser saw his rating plummet from excellent to the 12th percentile within a few months, on the basis of botched data. He was faulted for not controlling diabetes in a patient who did not have the disease and for not performing a Pap smear for a woman who had had a hysterectomy. Another physician was penalized for not doing a mammogram on a woman who had had a double mastectomy.

Schiesser, five other physicians, and the Washington State Medical Association are suing Regence BlueShield for defamation and deceptive business practices after the insurer told patients they no longer had access to 500 physicians who did not meet their quality and efficiency standards.

Doctors complain that they often have no way to correct erroneous data. They also protest that they are held accountable for patients who do not exercise or take their medications.

Doctors are rated against performance guidelines established by groups such as the American Heart Association.

Insurers say the trend is inevitable—though threats of legal action are delaying programs in some areas (Ellen Nakashima, Washington Post 7/25/07).

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