Doctors Rated but Can’t Get a Second Opinion

After 26 years of a successful medical practice, Alan Berkenwald took for granted that he had a good reputation. But last month he was told he didn’t measure up — by a new computerized rating system.
A patient said an insurance company had added $10 to the cost of seeing Berkenwald instead of other physicians in his western Massachusetts town because the system had demoted him to its Tier 2 for quality.
“Who did you kill?” the man asked sardonically, Berkenwald recalled.
In the quest to control spiraling costs, insurance companies and employers are looking more closely than ever at how physicians perform, using computers, mountains of health claims and billing data and sophisticated software. Such data-driven surveillance offers the prospect of using incentives to steer patients to care that is both effective and sensibly priced.
It also raises questions about the line between responsible oversight and outright meddling in the relationship between caregivers and their patients. And it shows how people such as Berkenwald are at risk of losing control of their reputations as corporations and other organizations mine electronic data to draw conclusions about them and post them online.
{This is another example of technology causing unforeseen and harmful consequences. We would never permit a drug or medical procedure to be used unless it was first proven safe and effective for human use. Why isn’t technology tested to be sure it is safe and accurate before it can used on doctors and patients? A representative of UnitedHealth Group said that “our focus is really on transparency”. Why not require insurers to be “transparent” and publish how often they deny claims for treatment, how often they reverse denials of claims for treatment, how often they retroactively deny claims already approved and paid, and the percentage of health premiums that pay for overhead (like executive salaries and administrative expenses) instead of paying for sick people to get needed medical treatment? ~ Dr. Deborah Peel, Patient Privacy Rights}

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>