In a September 2010 letter sent to the nation's largest insurers, the AMA cited a Rand Corp. study that "called into question the use of cost-profiling tools" in rating physicians. But over the past few years, Lazarus said discussions between the AMA and insurers have resulted in a shift.
"Many insurers agreed with us and are now basing their ratings more on quality of care than on costs," he said.
Some disagreements between insurers and physicians over online ratings have resulted in legal action. In September 2010, the California Medical Association sought a restraining order against Blue Shield, requesting that the insurer take down its online Blue Ribbon Recognition Program.
The program evaluated physicians based on data from the California Physician Performance Initiative and its database with information on more than 5 million patients and 63,000 physicians. The lawsuit, which was eventually dismissed in 2011, claimed the rating program did not include information from patient medical charts, patient outcomes, or a record of previous patient treatments and relied on data based on five insurance plans sold in the state going back just three years.
Provisions of the Patient Protection and Affordable Care Act could lead to the creation of new rating sites that use patient outcomes and clinical excellence as the basis for ratings.
"In theory, federal healthcare reform will require physicians to provide CMS with more data on quality of care," said Anderson. "But it's not clear how much of that data can be made available to patients."
Anderson said another outgrowth of healthcare reform—accountable care organizations—may provide a better vehicle for future rating systems, with hospitals, insurers, and medical groups sharing clinical results with the public to promote themselves as a destination for care.