President’s Message

Good Communication Can Ward Off Tiering Problems

The new “tiered” health plans offered through the Group Insurance Commission’s “Select and Save” program are now in effect (see related article).

If you or your practice has received a tier-2 rating, the MMS urges you to contact the health plan for a better understanding of tiering methods and to analyze the accuracy of the data. Physicians have every right to review this information and have it corrected if inaccuracies are found. Unfortunately, some physicians have received limited assistance when asking one particular Select and Save plan to discuss specifics. All health plans offering tiered products must communicate openly with physicians and respond promptly and professionally to our questions and concerns about accuracy and fairness.

Another way to address the confusion swirling around these plans is to talk openly about them with your patients, practice colleagues, and office staff. Make sure everyone knows where you stand on this.

Surveys suggest that fewer than 5 percent of people given a choice would switch doctors or their existing health plan based on tiering alone. This suggests that many patients are not only very satisfied with their care, but also are savvy enough to know that the bits of information used to tier physicians do not tell the whole story about the quality of patient care. Still, although many patients see tiering’s limitations, if you maintain strong physician-patient relationships -- both clinically and interpersonally -- you’ll help prevent tiering-based controversy from arising.

If physicians in a group practice have been tiered differently from one another, they should develop a communications strategy so they speak to patients in a unified voice. Reading the FAQs published in this issue of Vital Signs would be a good first step. And don’t delay training your office staff in how to communicate with patients about this new reality.

In responding to these programs, physicians should take a long, hard look at their individual and group processes. Although most of the rating data we’ve seen provides little or no information to help doctors identify practice shortcomings, this new transparency paradigm should prompt some self-examination. If you see anything about the way you practice that is legitimately off-kilter, take appropriate steps now to improve it.

Physicians must understand that business and government will continue pressing for health care cost containment. In response, individual physicians should redouble their efforts to adhere to accepted clinical guidelines. And the Society will continue to advocate forcefully for measures and methodologies that are both fair and accurate.

– Kenneth R. Peelle, M.D.