Medical Economics Story - October 2008
Tex Med . 2008;104(10):39.
By Ken Ortolon
UnitedHealthcare notified physicians and medical specialty societies in August of several changes in how it will rank physicians in its Premium Designation Program.
United says it will make "methodology enhancements" for 2008 for both quality and efficiency designations. Among the quality designation changes is an increase in minimum sample size to 30 measures among five patients. Larger sample sizes are more statistically robust, the company says.
Other changes include removing quality measures on obesity and reevaluation of acute otitis media within six weeks for children younger than 5 years. United says variations on obesity in member benefit plans could lead to inconsistent results that are not due to physician factors. It also said acceptable clinical variation and practice patterns for otitis media make that rule less applicable.
United also added quality measures related to hyperlipidemia and diabetes for infectious disease specialists and hyperlipidemia, hypertension, osteoporosis, depression, and diabetes for obstetricians and gynecologists. It also increased the quality threshold from 70 percent to 75 percent to "incent the delivery of the highest number of evidence-based services to our members."
Under its efficiency designation, United removed costs of routine examinations and vaccinations from cost-efficiency calculations and added a minimum threshold for attribution of episodes of care. A physician must now be responsible for at least 30 percent of an episode's cost to be evaluated for that episode.
Texas Medical Association officials say many of the changes to the Premium Designation Program came at the request of organized medicine. United says it looks forward to "working with physicians and state medical societies to make the operation of this program as fair, transparent, and convenient as possible."
In the meantime, the company also announced that physicians soon will receive their new assessment reports. It will base the reports on data from claims paid through Feb. 19 with dates of services from Dec. 1, 2005.
United will notify physicians of their individual designation status at least 45 days before public disclosure to give physicians the opportunity to seek clarification of the results and, if necessary, to request reconsideration.
Comprehensive information about the Premium Designation Program is on the company's Web site at www.unitedhealthcareonline.com .
Physicians with further questions about the program can seek additional information by phone at (866) 270-5588 or by e-mail at firstname.lastname@example.org .
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.
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