A call for physicians to denounce third parties once and for all

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with Kumar Yogesh, MD, a practicing independent physician in Dresden, Tennessee. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

When I began my career in medicine as a physician, patient satisfaction meant something for employers. If a physician had a reputation for bringing satisfaction to patients by practicing good medicine and treating people well, he or she was of interest to clinics and hospitals to hire.

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It seems to me that America’s healthcare system is deviating further each day from this simple idea as third parties are becoming progressively more involved in management of patient’s healthcare. The focus for medical directors and managers of clinics and hospitals has now become: How do we satisfy insurance companies and the government so we can get compensation for our physicians’ work?

When this happens, guess who gets to decide what “patient satisfaction” means? No, not, the patient. No, not you, the doctor. No, not even the management at your clinic or hospital. Yes, the third parties. That is, the people who do not even spend one second of facetime with the patient, the doctor, the patient-doctor exam room or the facility!

Recently, I received a letter from Humana to update me on “my performance” according to the company’s Physician Quality Star Rewards program. I was befuddled as I continued to read Humana’s perception of my quality of care given to my patients based on their data. The program is supposed to promote “improvement in quality and to recognize primary care physician practices for demonstrating achievements for specific NCQA HEDIS measures.”

The data illustrated my practice target performance in several areas, such as breast cancer screening, A1c diabetes control, high-risk medications in the elderly, and so on.

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First, from the perspective of a physician who diligently sees patients every day in a facility that is meant to provide healthcare to people, this data seemed to have been pulled from the sky. I have never had a visit from a Humana agent to collect any such data on patient quality of care or patient satisfaction. So where were they getting all of this information from?

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If anyone came to my practice to perform a random quality check on the care I give to my patients or to interview my patients, I cannot imagine he or she would leave with much dissatisfaction from the data collected. However, the notices that came in the mail from Humana suggested otherwise.

Second, as a pulmonary/sleep physician, most of my patients are referred to me by physicians who are already providing exceptional care to their patients in these areas. Why would Humana want me to interfere with other physicians’ work?

I was perturbed and called their 800 number. I was greeted by a friendly gentleman. When I explained this situation to him, he understood that as a consulting doctor, I did not have to interfere in these areas and told me not to worry about it. Subsequently, I repeatedly asked him to remove this erroneous information from my record; however, he could not give me a satisfactory answer that this would happen.

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As a pulmonary physician, I thought my job was to learn about ARDS, IPF, COPD, etc., which I have a passion for. Suddenly, such outside parties are now forcing me to learn terms like NCQA and HEDIS, which causes unnecessary turmoil. I would think that all of our fellow physicians are experiencing similar issues in their practices as well. A great question is: Why have we, as physicians, allowed all of this to happen?

Eventually, my suspicion is that the creation of such erroneous data by insurance companies, if not corrected, can lead to the accumulation of negative information against us, causing harm to our reputation and penalties against our compensation. Or maybe this is a sadistic way for third parties to kick us out of their plans.

A distant analogy would be the current situation happening with NFL. Just like I want to mind my own business being a doctor (and not being bothered by issues like HIPAA and HEDIS), most avid NFL fans also want to be left alone watching the game on a quiet Sunday. Suddenly, the one refuge where fans could go to vent their frustrations and de-stress is being hijacked by political agendas, causing great turmoil, and seizing enjoyment from fans’ Sunday afternoon.

I have a strong feeling that when we receive these letters from regulatory agencies and insurance companies, the well-being of my patients is the last thing on their mind. I think they always have ulterior motives as their bottom line. Similarly, the idiots creating havoc in the NFL probably care the least about the fans and the true spirit of the game.

I appeal to my fellow physicians, let us denounce with a single voice such practices by third parties. Let’s demand that we just want to be doctors with control of the field we practice in. To hell with HIPAA, ICD-10, CPT, NCQA and the rest.