Whether your a fan of insurance company rating systems or not, the impact was dealt a serious blow recently when Cigna altered its ratings of physicians in lieu of the scrutiny of New York Attorney General Andrew Cuomo. Through various methods including financial incentives, steerage, and rating systems viewed on consumer websites, payors had been increasingly trying to drive patients to practitioners that they deem quality based on their system of measuring results.
As Sarah Rubenstein points out in her WSJ post insurers have been getting flack recently. Cuomo sent letters to Cigna, Aetna, UnitedHealth Group, WellPoint’s Empire Blue Cross Blue Shield and other health plans asking them to justify methodologies and warning them not to launch programs in New York without their approval.
Which is worse, having indefensible methodology to rate quality or having to get approval by the government?
The fact that this trend is already going on with physicians appears to me to at least derail attempts to do the same thing to physical therapy providers via P4P or other systems. This also is consistent with at least one poll of consumers where only 38% think providers should be paid more based on producing better results.
Discussion. Should payors reimburse PT providers more if they can show thru defensible methodology that the PT provider is using EBP and/or has better results?
