UnitedHealthcare made the physician ratings under its Premium Designation program public on its member Web site on April 1. The program rates physicians on quality and cost-effectiveness criteria [ PDF ]. A physician who meets the quality criteria receives one star, and a physician who meets both quality and cost efficiency criteria receives two stars.
United says it has added six Texas markets to the Premium program - East Texas, Waco, Beaumont, Corpus Christi, El Paso, and Victoria. It is used in 138 markets nationwide.
United calls the program a "physician performance assessment initiative that uses evidence- and consensus-based medicine and national standards to evaluate physicians in 20 specialties for quality and cost efficiency of clinical care." It adds that it gives information to help physicians "in their continuous practice improvement and to assist consumers in making more informed and personally appropriate choices for their medical care."
Physicians can ask United to reconsider [ PDF ] their ratings. TMA is tracking physicians who do appeal. If you are considering filing an appeal, send a quick e-mail to Genevieve Davis in the TMA Payment Advocacy Department. Put "United PDP Appeal" in the Subject line, then add this message: "I am considering an appeal of my UnitedHealthcare PDP rating. My TMA membership number is XXXXX." Or, you may call the TMA Knowledge Center at (800) 880-7955. We will follow up with you shortly to find out if you did protest your rating.
The rating program, evaluates:
- Allergy,
- Cardiothoracic surgery,
- Electrophysiology,
- Endocrinology,
- Family medicine,
- Infectious disease,
- Internal medicine,
- Interventional cardiology,
- Nephrology,
- Neurology,
- Neurosurgery,
- Noninterventional cardiology,
- Obstetrics-gynecology,
- Orthopedic surgery,
- Pediatrics,
- Pulmonology,
- Rheumatology,
- Spine surgery,
- Sports medicine, and
- Total joint replacement.
TMA believes any rating system should be fair to doctors and useful to patients.
Action , April 1, 2009
Last Updated On
May 13, 2016
Originally Published On
March 23, 2010