Health plan doctor ratings: Will they ever be fair?

Here’s a tough assessment of doctor-ratings schemes by my buddy Joe Paduda of blog Managed Care Matters:

“Some physicians and physician groups are quite upset about insurers’ recent moves to offer employer customers tight, small networks of providers based on quality and cost criteria. In an effort to block these new plans, the AMA and other groups are focusing on the few problems with ratings and avoiding the larger issue – some physicians are just bad actors.

What they should be doing is working closely with health plans and regulators to ensure the rating process is transparent, fair, and objective.”

I’m not sure I agree with Joe, though he is, to be sure, a guy one should take very seriously when it comes to healthcare strategy. I think a lot of the talk about “quality” is just an excuse to squeeze out expensive or challenging doctors and practices.  But what about you?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I think the AMA has dithered long enough about the issue of rating physicians. They had decades to develop their own system, failed utterly and miserably and, instead, used the time only to perfect the skill of criticizing everybody else’s attempts. Sorry, AMA, that train is long gone from the station.

  • There is no such thing as a completely accurate rating system. Any comment at all CAN be misleading – however, a transparent system , with all its problems, is better than no infirmation at all.-


  • Ted, I completely agree that transparency is good, but I’m still not comfortable with the health plan solution. I’m afraid I don’t consider health insurers generally to be capable of the kind of transparency would be called for. It’s not in their financial interests to admit they’re rating doctors on say, rates of costly procedures, is it? And while some would truly focus on clinical measures and patient satisfactions, others would be all about costs to the exclusion of other quality factors. That’s my position and I’m stickin to it. 🙂

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