"Often insurers will do a two-step process," says Ha Tu, a senior health researcher at the Center for Studying Health System Change, a nonpartisan research and policy organization based in Washington. First, they "make sure doctors meet a quality threshold, but not a very high one. Then they'll weed them out further based on cost."
Complicating the situation for consumers is the fact that every insurer measures these variables differently, and there are no agreed-upon standards for which combination of attributes makes a top-notch doctor. In fact, a physician who receives a top rating from one insurer may receive a middling or even low score from another, says Elizabeth McGlynn, associate director at Rand Health, a division of Rand, a think tank based in Santa Monica, Calif.
It's no surprise then that doctors are resistant to many insurer efforts to rate physicians. In a recent letter to 47 health plans, the American Medical Association and 46 state medical societies asked the plans to improve the accuracy, reliability and transparency of physician ratings. To support this call for change, the letter pointed to research by Rand that examined physician cost profiles and found that health-plan ratings were inaccurate up to two-thirds of the time.
The quest for a common, accepted definition of quality continues.
