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Physicians, Insurers Agree on National Standards for Doc Performance

By Christine Grimaldi, CQ Staff

April 4, 2008 -- Physicians, insurers, and others have agreed this week on a set of national standards for evaluating and reporting physicians' performance.

Developed by the Consumer-Purchaser Disclosure Project, a coalition of consumer, labor, and business organizations funded by the Robert Wood Johnson Foundation and its participants, the standards are outlined in a "patient charter" and comprise four main criteria:

  • measures should be meaningful to consumers and reflect a diverse array of physician clinical activities;
  • those being measured should be actively involved;
  • measures and methodology should be transparent and valid; and
  • measures should be based on national standards to the greatest extent possible.

The patient charter also encompasses a number of subcriteria. Providing both quality and cost-efficiency information are listed as meaningful measures to consumers. The charter also says that active involvement would give physicians notice and a chance to request to review and correct potential inaccuracies in their performance reports before release.

"By signing on, [health plans are] going to retain an independent organization to look over their shoulder," said Peter V. Lee, the co-chairman of the Project and executive director of national health policy for the Pacific Business Group on Health, a participating organization.

Potential reviewers include the National Committee for Quality Assurance and the Utilization Review and Accreditation Committee, Lee said.

The health plans will be able to choose their own oversight, but the Project will review the reviewers to ensure adherence to the patient charter standards, he said.

"The Patient Charter creates sound, uniform principles for the measurement and public reporting of physician performance," said America's Health Insurance Plans president and CEO Karen Ignagni in a news release. "These principles should be endorsed by all stakeholders as the nation moves toward a health care system that values quality and embraces transparency." American Medical Association President-Elect Nancy Nielsen also approved of the criteria. "Instead of tiered and narrow networks, the AMA believes that providing valid data to physicians and patients will better improve the quality and efficiency of care," she said in a statement.

Consumer, labor and employer groups endorsing the standards are AARP, AFL-CIO, the Leapfrog Group, the National Business Coalition on Health, the National Partnership for Women and Families, and the Pacific Business Group on Health, a news release said.

Physician groups include the American College of Physicians, the American Academy of Family Physicians, the American Medical Association, the American College of Cardiology, and the American College of Surgeons.

Insurers include the America's Health Insurance Plans, Aetna, Cigna, UnitedHealthcare, and WellPoint.

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