What Is Physician Ranking?

Physician ranking has traditionally been a profiling methodology used by private insurance companies to steer patients toward lower-cost physicians.  

Many insurers are increasingly offering incentives for patients to chose physicians deemed as providing lower-cost, and some plans award bonuses to doctors who are deemed “low cost.” Similarly, the health care reform legislation promotes “value-based purchasing,” which would rely on a classification system to analyze physicians’ costs and determine who spends relatively less than their peers while delivering the same quality of care.

According to research, however, many physicians who have been ranked as “lower cost” doctors according to a common formula used by insurance companies are not actually treating patients for any less than physicians with comparable practice patterns. Cost-ranking physician profiles currently in use are not scientifically sound and are poor indicators of the quality of care provided to patients.

TMA believes that neither Congress nor any other institution or company should publicly profile and penalize individual physicians based on faulty methodology. We believe that any standard used to measure physician performance and quality must meet the following:

  • The criteria used to evaluate a physician must be evidence-based, fair and accurate, and truly evaluate quality and efficient care, not just cost.
  • The criteria or performance standards must be disclosed to the physician prior to the evaluation period, and include adjustments based upon regional variations in population and health status.
  • The data used to establish the ratings or tiering must be made available to the affected physician prior to publication.
  • The system must allow for a due process for the physician to correct inaccuracies in the data prior to the publication of any ranking or tiering decision. 

TMA discourages implementation of any ranking system to evaluate physician performance unless it is based on solid science. Inaccurate information only serves to mislead patients and physicians without improving the quality of care or reducing costs.  

Physician Ranking main page

Last Updated On

May 13, 2016