Four Star Care

The business of rating physician care is a tricky one and has resulted in strained relations between health plans and providers on more than one occasion.

The issue came to a head last fall in New York State when Attorney General Andrew M. Cuomo confronted the state's health plans about the science behind their ranking systems and the way they presented the findings to consumers. In the interest of fair play and transparency, Cuomo struck agreements with the major players in the New York insurance market to establish guidelines for ensuring the programs offered consumers a realistic picture of the care offered by the physicians and were not just a means for directing consumers to the lowest cost providers in the network.

These guidelines included requirements that plans not base rankings solely on costs and that they identify to what degree cost played a role in the rankings. Plans also have to disclose to consumers and physicians how the rankings are designed and to provide a process for challenging the ratings.

One of the plans that agreed to this new process was Empire Blue Cross and Blue Shield, an affiliate of Indianapolis-based WellPoint Inc. Now, however, WellPoint is building on the issue and is taking objectivity in the area of physician ratings a step further by removing itself entirely from the process.

WellPoint rolled out a new physician rating service in partnership with Zagat, the well-known publisher of consumer guides for restaurants, hotels and nightspots, that leaves the job of rating providers to the end consumer of care--the doctor's own patients. WellPoint is testing the system by making it available to 1.3 million members enrolled in its consumer-driven health plans in four markets--Los Angeles, Connecticut, Cincinnati and Dayton, Ohio. Later this spring, WellPoint will open the ratings system to all of its enrollees in these markets.

Physicians will be judged on a 30-point scale--just like restaurants and hotels have been for decades--in four categories: patient trust, communication, availability and practice setting. Patients will also be able to leave comments about their experience, which provides that peer-to-peer aspect that makes Zagat's restaurant and hotel reviews so popular.

While physician organizations are rightfully cautious about another new ranking system coming down the pike, I think this partnership could be good for the industry. It brings a respected name in the ratings business into the healthcare arena--one that's unencumbered by the baggage of past efforts to rate the patient care experience. It also offers consumers a ready forum to share their personal experiences--a forum that many are already comfortable participating in through the firm's other ratings services for restaurants and hotels.

But the unique dynamics of the physician/patient relationship have defied common sense interpretations in the past. Will consumers remove themselves from the role of patient and evaluate their physician truthfully and accurately? Will Zagat and WellPoint be able to police the forums in a way to prevent unfounded accusations, but still encourage open discussions on the issues? It's a new step, but one that needs to be taken.