26 Northfield area doctors rated highly by Medica on quality and cost-efficiency. Is it helpful? Is it fair?

Medica Premium Designation

Today’s Strib: Medica posts controversial doctor ratings

For the first time, the Medica health plan today began publicly rating thousands of Minnesota doctors on its website, Medica.com, in an effort to give consumers more information on their health care providers. The state’s second-largest insurer is using a "star system" to indicate which doctors meet certain thresholds for quality and cost-efficiency in 20 medical specialties.

Medica posted the ratings Wednesday in spite of pleas from the Minnesota Medical Association (MMA) to delay publication. The MMA says the system is prone to errors and unfair to doctors. Medica used three years’ of patient claims data to determine which doctors adhere to national treatment guidelines, and which have higher than average costs.

The MMA has posted a release on it’s website titled: MMA finds significant errors in Medica’s physician rating program

After reviewing the Medica Premium Designation Program, the MMA raised three serious concerns about the program: a lack of reliability testing to assure statistical accuracy in physician results, a lack of Minnesota physician involvement in the development of the rating program, and a woefully inadequate timeline for physicians to review their results and the data underlying their results.

You can search the database to find how individual doctors scored (1 star for quality, 2 stars for cost and quality).

My screencapture image on the right is the result of searching all providers within 5 miles of zip code 55057. The results came back with "More than 100 providers met the preferences you selected. The closest 100 have been returned." I then sorted those by name and listed them all on one page. Click the image, and then after the larger image pops up, click the green arrow to enlarge it further.

I counted 26 Northfield area physicians on that list of 100 with 2 stars on the Medica Premium Designation system which says:

Northfield Physicians rated by MedicaLook for the stars. Find the care you deserve. When you’re looking for a physician, simply look for the stars. They mark physicians who have met standards for quality and cost-efficient care.*

One star means a physician has met nationally recognized standards for delivering high quality care.

Two stars means a physician has been recognized not only for providing quality care, but also for meeting local benchmarks for providing cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they’re more likely to recommend the right tests and treatment at the right times.

How do you benefit from all this? It’s simple – a doctor with two stars has proven he or she delivers value.

Your plan does not require you to use Premium Designation physicians, but when you do, your total costs for the treatment of a condition will be on average 10-20% less.

Premium Designation physicians, as a group:

  • Have lower surgery repeat rates
  • Follow nationally recognized guidelines for care, and
  • Are more likely to be aware of the latest research and clinical trials.

4 comments to  (Including One Discussion Thread)26 Northfield area doctors rated highly by Medica on quality and cost-efficiency. Is it helpful? Is it fair?

  • 1
    Arlen Malecha says:

    So what does it all mean? One star means that Medica Quality Care was provided. Two stars mean that Medica Quality Care was provided and Cost Efficiency Criteria was met. But what does this all mean to the consumer? How are we to know what Medica’s Quality Care standards are or what the Cost Efficiency Criteria is? Are these two Medica measuring sticks in the best interest of the consumer or in the best interest of Medica and their bottom line?

    Does it really matter to the consumer that their Doctor made the list with one star or two stars or any stars at all so long as the patient is comfortable and confident with their Doctor?

    Before Medica came out with “the list”, my family and I were very much comfortable with our Doctors and knew they were … wait for it … “all stars” that provided quility medical care.

  • 2

    This whole doctor rating thing is important. First, I heard that 89% the docs in mn rated high as possible. I was never into getting annual check ups or anything, but the doctor who took out my appendix when I was nine and whose name I still remember,was the best doctor in the world because he saved my life.

    People are hard pressed to be objective about their doctors. So, this type of rating may be the closest thing to getting a handle on quality care.

  • 3
    Jane Moline says:

    Some excellent doctors were listed as “not evaluated” while some I wouldn’t let close to me or my family had 2 stars. I think the rating system does not give good information.

    • 3.1
      Phil Poyner says:

      I think part of the problem with ratings is that people value different things in doctors. Some of those doctors you wouldn’t let close to you may be just fine in my book. A rating system that isn’t tailored to my idea of “good” isn’t going to be very helpful to me.

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