The Academy of Medicine of Cleveland & Northern Ohio (AMCNO) Spearheads Legislation to Address Physician Ratings in Ohio

After several months of working with the AMCNO leadership and lobbyists, Representative Barbara Boyd, Chair of the Ohio House Health Committee (D-9 –Cleveland), has introduced HB 122 – legislation meant to address the issue of physician ratings by insurance companies in Ohio. Senator Tom Patton (R – 24 – North Royalton) is also working on companion legislation for introduction in the Ohio Senate.

The purpose of this legislation is to provide patients with accurate information when selecting a physician. This legislation would prevent health insurance companies from ranking physicians based solely on specific criteria to persuade a consumer to choose one physician over another. The designations would be made based on cost efficiency, quality of care or clinical experience. This legislation will establish standards for the physician designations. It stresses that health plans must use risk-adjusted data, base grades, and ratings at least in part on nationally recognized quality of care measures. The legislation also allows physicians the right to review and appeal their ratings prior to the ratings being released to the public. If passed, Ohio will be on the forefront of implementing important new policy that promotes accurate, safe and effective health care transparency for everyone.

The issue of physician ranking has been hotly debated for several years. In recent years, there has been an increase of physician ranking across the country. Insurers have supported obtaining data in order to tier and quantify cost effective care, and consumers have wanted data to compare quality of doctors. The crux of the debate is balancing the rights of physicians to have accurate and relevant reporting of their practice with the desire of health insurers and consumers to have access to information about their treating physician.

In the past, there has been a lack of scrutiny that has enabled health insurers to unfairly evaluate a physician’s individual work by using an insufficient number of patient cases, questionable quality measurements and poor risk adjustment systems.

The AMCNO is of the opinion that doctor rankings can be confusing and could be used to steer patients to the least-expensive health care providers, rather than being based on quality. It is important that the insurance companies are truly reviewing quality issues versus cost and claims data, and the data must be accurate with the ability of physicians to appeal their data.

"We're very interested in making certain that information regarding physician quality outcomes that are going to be used by patients and businesses is accurate, verifiable and that the process is as transparent as possible," said Dr. John Bastulli, Vice President of Legislative Affairs for the AMCNO. "We want to be certain that the public can understand the cost and why it may vary between health-care professionals. That way, those that are using this information can understand what went into the process."

The legislation stresses that health plans must use risk-adjusted data, and base grades and ratings at least in part on nationally recognized quality of care measures and not on cost alone. The legislation also provides physicians with the right to review and appeal their ratings.

The Academy of Medicine of Cleveland & Northern Ohio supports physicians in being strong advocates for all patients as well as promoting the practice of the highest quality of medicine. AMCNO advocates on behalf of its more than 5,000 members as the region’s premier professional medical society since its founding in 1824.