Friday, September 09, 2005

Texas Medical Association skeptical of UHC's "Premium Designation Program"

UnitedHealthCare representatives have met with the Texas Medical Association's (TMA) leaders to introduce their program designated as Premium Designation Program which will hand out stars to good doctors. I still remember the stars I was awarded on my grade school papers. Physicians who meet either the quality standards or the efficiency standards that UHC devises with be designated as either having one or two stars (two if both criteria are met) and a triangle will be the scarlet letter for those whose data is insufficient to analyze or if their specialty is not included in the program. Apparently the grading system will be based on claims data.UHC said that initially the program won't be used to penalize or reward physicians monetarily. Writing in the September 2005 issue of Texas Medicine , the senior editor quoted a 7/21/05 letter from the TMA General Counsel to UHC in which the TMA wanted to make it clear they did not endorse the program. Several physicians who attended UHC briefing sessions complained that UHC either implied or stated that their program was endorsed by the TMA. A program in which a star is given on the basis of claims reviews for "efficiency" is not a quality initiative. It is a cost containment mechanism. The program as currently touted by UHC seems to contain none of the AMA 's five requirements for a quality improvement type P4P program. Typically, TMA has been a strong advocate for physicians and patient care and so far it is willing to point out exactly how the emperor is dressed. The insurance industry's Trojan horse of quality seemed to have been welcomed within the walled city of the American College of Physicians (ACP) and perhaps other national medical organizations. While I continue to hope that national organizations can make a difference, I believe that meaningful resistance to this latest cost containment-profit enhancing- initiative of big insurance will be at the level of the state and local medical societies.

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