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Challenging your rating: You don't have to accept what the health plan says

Like many doctors practicing in Massachusetts, Cambridge pediatrician Michael Yogman, MD, MPH, had an early and unhappy experience with physician ratings. Beginning in July 2006, after a mandate from the state's Group Insurance Commission, which handles benefits for public employees, physicians who contracted with Tufts, Unicare or Harvard Pilgrim were ranked for quality and cost. The rankings meant more than a gold star or lack of one in a physician directory -- they meant a higher co-pay for patients to see doctors who were not in the highest tier. When one of the three plans didn't rate him in the highest tier, Dr. Yogman said he first got mad. Then he got busy with an appeal. "I took it as a personal assault on my integrity," he said. "I was not about to stand for being considered a less-than-optimal physician on anybody's ranking." Many physicians either upset with health plan rankings in general, or particularly upset at, what they feel is an unfairly low ranking shar ...

Changing history: The questions you ask patients keep expanding

After Martin Duke, MD, retired as director of medical education and chief of cardiology at Connecticut's Manchester Memorial Hospital, he found himself more often the patient than the physician. As a result, he spent more time giving his medical history than taking someone else's, and he noticed significant changes in how the task was accomplished. The time spent on it was shorter. It often was taken by an allied health worker. And, sometimes it didn't even involve a face-to-face conversation. Instead, he simply checked "yes" or "no" boxes on a questionnaire. In a paper he authored in the November-December 2008 Connecticut Medicine, he bemoaned this shift. "If this trend were to continue, it is conceivable that one day patients and doctors may not even be speaking with each other," he wrote. "Technology has changed the whole approach, and technology does add something," said Dr. Duke in an interview. "But it cannot stand by itself. It needs the person-to-person interaction for so ...

Self-insured companies going after doctors to recover

When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter -- vaguely threatening, insistent on a quick response, with few details. The letter, addressed "Dear Health Care Professional," accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. "Of course, I was offended," Dr. Fine said. HRI's letter offered him two choices: pay $347 to "immediately settle this issue" or send complete records proving he did not incorrectly bill for the visits in question. The letter warned that if Dr. Fine did not pay HRI or contact them with records to prove his innocence, his case could be turned over to federal authorities. "The intimidation is really strong here," he said. "They are working under the guilty-until-proven-innocent philosophy." HRI, which sent Dr. Fine the letter in February, works on behalf of large compani ...