Finding a good new doctor when switching insurance - East Valley Tribune: Health

Finding a good new doctor when switching insurance

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Posted: Thursday, September 16, 2010 10:30 am

The annual fall migration among health plans is gearing up. And whether you're switching coverage on your own or facing changes dictated by an employer, the season of change may require finding at least one new doctor.

So how do you find a good one from the new plan's list of providers?

There are oodles of websites that offer ratings and background on physicians. Unfortunately, recent research suggests that most of the publicly available information included in these physician report cards doesn't reveal much about the quality of care they provide.

The latest study, done by researchers for the RAND Corp. and the University of Pittsburgh School of Medicine, matched typical doctor scoring information for about 10,000 Massachusetts physicians against how they actually cared for 22 common medical problems among more than 1.3 million adult patients.

And basically, not many characteristics seemed to predict whether the doctors would deliver all the care recommended under the latest evidence-based guidelines.

"We found that the types of information widely available to patients for choosing a physician do not predict whether that physician will deliver evidence-based care," said Rachel Reid, the study's lead author and a medical student at Pitt. The research was published in the Sept. 13 Archives of Internal Medicine.

While most report cards highlight things like where a doctor attended medical school, their years of experience, past disciplinary actions or if they've paid claims due to malpractice, the researchers found only three factors made any measurable difference: being female, being board certified in a specialty and being a graduate of a domestic medical school.

Overall, the doctors provided about 63 percent of all recommended care. But even among those with the three positive characteristics, the performance improved by an average of just 6 percentage points -- not enough to make it worthwhile to seek out such doctors, the researchers said.

Doctors have been griping about the unfairness -- and sometimes inaccuracies -- of ratings systems for years, with the American Medical Association and most state medical societies formally complaining to insurers in July that the systems health plans use to score how physicians control costs are wrong up to 66 percent of the time, based on another RAND study.

Another study reported earlier this month in the Journal of the American Medical Association, underscores another common complaint about quality ratings -- doctors' success to a great extent is dictated by who their patients are.

Researchers at Massachusetts General Hospital found that the ratings of primary care doctors affiliated with the hospital scored much better when they were caring for older men with several health problems who made frequent visits to the doctor and scored lower when their patients were minorities, non-English speaking, covered by Medicaid or uninsured, and lived in low-income neighborhoods.

Still, even if the ratings systems are primitive, doing a little doctor shopping on the Web can still be useful as part of a careful search that also includes asking friends, family, and even your current doctor (if you have a good relationship) for recommendations as you explain why you have to leave. (You may even find out they're changing the plans they work with, too.)

While few doctors have the time to be interviewed by prospective patients, it doesn't hurt to ask; some practices also offer patient references, although they tend to be for doctors with practices that operate outside insurance plans.

Health plans are also giving more quality rating clues for the doctors on their websites (including which hospitals they work with), and private (fee-based) ratings services might still be worthwhile for some patients. It's free to look up the status and any disciplinary history of doctors with state licensing boards and to check on specialty certification through the American Board of Medical Specialties (abms.org), although the specialty data is not necessarily always up to date.

One key in finding the right doc is to start looking early so you can make a good transition and have copies of your medical records in your hands and in the files of your new physician.

It's also a good idea to not only line up a primary care doctor, but also make sure any specialists you've seen in the past few years also work with your new plan. If not, make getting referrals from your new doctor part of your first visit.

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