Economic profiling can have effects on ophthalmic practice
Insurers are funneling patients to providers based on cost and quality data that may not always be accurate, said Ruth D. Williams, MD.
San Francisco-Insurers are funneling patients to providers based on cost and quality data that may not always be accurate, said
Dr. Williams, president of the Wheaton Eye Clinic, Wheaton, IL, described this problem in economic profiling at the
Insurers are trying to use statistical methods to shift patients to lower-cost, higher-quality providers, she said.
The insurers use grouper software, cost data, and patient satisfaction data to rank providers in tiers, but rarely more sophisticated measures of quality, she added.
Watch as Ruth Williams, MD, provides details behind economic profiling and its effects on the ophthalmic practice.
“The methodology is opaque,” she said. “When there is not sufficient quality data available, they use cost data.”
The insurers charge higher co-payments for providers in lower tiers. In general, existing patients do not change providers because of these rankings, Dr. Williams said.
“However, if it’s a new patient, and they’re trying to figure out who to go see, they’re going to pick the patient who has the lowest co-pay,” she said.
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