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Health Plan Orthopedist Tiering Found Biased, Inconsistent

Percentage of physicians rated as top-tier varies greatly from plan to plan

FRIDAY, Sept. 24 (HealthDay News) -- Current methods used by health plans to rank orthopedic surgeons by quality performance and cost-efficiency are not consistent and appear to have geographic and other biases, according to a study in the Sept. 15 issue of the Journal of Bone & Joint Surgery.

Ajay D. Wadgaonkar, of the National Institutes of Health in Bethesda, Md., and colleagues collected health plan tiering, demographic, and training data on 615 orthopedic surgeons who practiced in Massachusetts and were ranked by one or more of three health plans. The researchers compared the orthopedists' tier rankings between health plans and assessed the factors associated with top-tier ranking.

The percentage of top-tier physicians in the health plans ranged broadly, from 21 to 62 percent. Only 5.2 percent of physicians were rated in the top tier by all three health plans, while 38 percent were not rated top-tier by any. Being board-certified, practicing in a suburban location, and accepting Medicaid were the factors most associated with top-tier ranking, while having fewer malpractice claims and more years in practice were not related to tier ranking.

"Further research is needed by both physicians and health plans in the area of physician tiering. Ongoing efforts to validate the tiering methods against clinical data are needed," the authors write.

One or more authors, or a member of his or her immediate family, received payments or other benefits or a commitment to provide such benefits from commercial entities.

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