HMO Releases Scorecard on Doctor Groups

PacifiCare Health Systems Inc., which operates one of the nation’s largest health-maintenance organizations, on Monday issued scorecards for its medical groups in California, a move company officials say is aimed at stoking competition and improving physician services to consumers.

The firm’s so-called quality index marks the first time an HMO has made rankings of its medical groups available to the public.

“This is one way of having the voice of the consumer more clearly heard,” said Sam Ho, medical director and vice president of the Santa Ana-based HMO. “Consumers are going to be armed with information about medical groups and therefore can vote with their feet. Because of this, patient care will be improved.”

The quality index identifies the medical groups’ top performers--those in the top 10% of a particular category--with a ribbon printed alongside their names in PacifiCare’s new provider directory.

The directory does not list the low scorers, but members can find out how their medical groups fared by writing to PacifiCare.

The directories are being released this week, the start of open enrollment season, when many HMO members switch their health plans.

The 120 medical groups named in the rankings treat 1.3 million Californians and employ 30,000 physicians. PacifiCare executives say they plan to compile similar rankings next year for the nine other states where it operates.

Consumer activists welcomed PacifiCare’s decision to publish the index, saying it was an important first step to give consumers critical information.

“It’s a very good idea,” said Peter Lee, director of consumer protection programs for the Center for Health Care Rights, a Los Angeles nonprofit group. “In California, care is being organized and delivered more and more at the medical group level. Consumers need to understand that the choices they make between medical groups can be as or more important than the choice they make between health plans.”

But reaction was mixed among doctors in the medical groups ranked by PacifiCare. Some protested the HMO’s decision to publish the rankings, saying they were based on incomplete data, according to Ho.

Others, like Marvin Gordon, chief medical officer of Monarch HealthCare in Mission Viejo, were “cautiously optimistic.”

“These rankings are not a true reflection of quality,” Gordon said, “but it is a beginning of what we need to do as physicians--develop [a way to measure] our performance. We will use this information to tell our physicians that they can do even better.”

PacifiCare’s rankings measure 14 categories of patient care and service, ranging from cervical cancer screening to patients’ satisfaction with their primary care physicians.

The HMO compiled its rankings using its own data supplied by patients, the medical groups and its own records. New rankings will be issued in February.

Ho said PacifiCare has been providing medical groups with such rankings for the last 3 1/2 years. Officials decided to release the same information to consumers “so that they can have a new tool to make more informed health-care decisions,” he said.

Giving consumers comprehensive information on how medical groups rank in clinical and member service areas has become a hot topic in the national debate on health care, according to Judith Bell, director of Consumers Union’s San Francisco office.

“The concept being used by PacifiCare is the right one,” Bell said. “We have to wait and see if these are rankings that consumers can have confidence in.”

Ho said he believes the rankings are reliable, though he acknowledged they need a little “fine-tuning.” Publishing the rankings, he said, could result in a windfall to the top medical groups--and increase competition among them.

“Members are going to rush to the groups with the ribbons,” Ho said. “These top-performing groups will want to stay on top and others would want to break into the top tier. Competition becomes a tremendous driver for quality.”

But executives with some medical groups listed in the top ranks in some categories said they would not rely on the data.

Gordon of Monarch HealthCare pointed out that his firm received a top rating for retaining its Medicare patients. Members in the same plan ranked Monarch in the lowest quartile for members’ satisfaction with their primary care physicians.

“Why aren’t these people voting with their feet?” Gordon asked.

Ho said he could not explain the “incongruity.”

Robert Margolis, chief executive for HealthCare Partners Medical Group, which has 300,000 patients in Los Angeles County, said the index was imperfect but a commendable effort. “It doesn’t necessarily suggest who’s good and who’s bad,” said Margolis, whose firm received a combination of blue ribbons and lower scores by PacifiCare. “It should be taken as a work in progress.”