Ohio doctors, health insurers clash over physician ratings bill

Ohio’s leading doctors and health insurance groups are clashing over legislation that concerns standards for insurers’ physician rating programs.

Physician rating programs are employed by a number of insurers as a means of assessing doctors’ performances — typically based on quality and cost — and then steering patients to doctors who are rated highly. The programs often place doctors in different categories designated by stars (four stars, three stars, etc.), or other means of categorization such as gold, silver and the like.

Doctors sometimes complain that the rating programs focus too much on cost, without regard to the quality of care physicians actually provide, and that the ratings are often inaccurate, The New York Times (pdf) reported.

The legislation in question, Senate Bill 121, calls for Ohio health insurers to follow a set of national standards developed by insurers and doctors known as the patient charter in structuring their physician rating programs.

The state’s largest physicians group, the Ohio State Medical Association (OSMA), “strongly supports” the legislation as written, spokesman Jason Koma said.

“If health insurers are going to put together these programs, we just want to ensure that they’re fair and transparent and not just based on cost,” Koma said.

Insurers’ group the Ohio Association of Health Plans (OAHP) does not support the legislation in its current form.

“We’re not opposed to the concept, but we’re opposed to the language,” said Kelly McGivern, OAHP’s president. “It’s too broad.”

McGivern said Ohio insurers are OK with using the national standards for physician rating programs that are made available to the public. What the insurers object to is the bill’s requirement that they also apply those national standards to internal programs such as pay-for-performance or medical home projects.

“It’s really the scope of the bill that’s in contention,” McGivern said.

The insurers maintain that changing standards to their internal programs midstream would compromise the data and put the programs “in jeopardy,” McGivern said.

The bill hasn’t made it to a vote.