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Doctor Cost-Efficiency Listings Are Misleading

An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].

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An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].

An insurance company recently sent me a letter that said they’re going to start marking doctors in patient directories as to whether they’re cost efficient. This is done by "a methodology consistent with national standards ... based on a comparison of fee schedules, utilization patterns, and referral patterns."

I support the overall idea of cost efficiency, and try to follow it. I don’t order MRIs for everything, and typically start with conservative approaches before moving up. I prescribe generic medications when possible. I know patients want to save money, and I know that higher insurance costs affect all of our premiums.

But being cost efficient is certainly not the whole story in medicine. If I were to have a practice of primarily multiple sclerosis patients, I certainly wouldn’t be considered a cost-efficient doctor. Those patients will likely require far more costly drugs and frequent MRIs than someone with lumbar pain or migraines. Even if you’re an excellent doctor, you won’t get good marks for "cost efficiency."

The doctor who saves the most money isn’t necessarily the best doctor. Hell, I can do that. Don’t order expensive tests, diagnose based on clinical grounds, and treat with whatever is cheapest (amitriptyline, phenobarbital, aspirin). I’m sure I’d do fine for a while, until something serious is missed. That’s when the whole thing, medically, ethically, and legally, falls apart.

It’s not all about saving money. Dr. Linda Peeno, the whistleblower on the managed care industry, can tell you that. But rating doctors just on that measure can be misleading at best, and dangerous for all involved at worst.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. E-mail him at [email protected].

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Doctor Cost-Efficiency Listings Are Misleading
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Doctor Cost-Efficiency Listings Are Misleading
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