Despite all the publicity about quality-of-care report cards for cardiac surgeons in New York State, managed care organizations (MCOs) appear to make only limited use of them when they decide to contract with cardiac surgeons, according to a survey of MCOs supported by the Agency for Healthcare Research and Quality (HS09803). Regardless of an expressed preference for high quality providers by the majority of MCOs—60 percent of those responding ranked the quality of surgeons as most important in their contracting considerations—analyses of actual contracting practices offered mixed results.
Sixty-four percent of New York MCOs indicated knowledge of the New York State Cardiac Surgery Reports, but only 20 percent said the reports were a major factor in their contracting decisions. Furthermore, analyses of the actual contracting patterns revealed that MCOs did not systematically select surgeons based on their reported mortality scores, nor did they systematically avoid surgeons designated as low-quality outliers. MCOs were, however, more likely to contract with high-volume surgeons and surgeons designated in the report cards as high-quality outliers. It may be that, despite their survey responses, MCOs are currently more influenced by costs than by quality in their network choices, or that they use information other than the New York State-reported mortality data to evaluate quality, suggests Dana B. Mukamel, Ph.D.
Dr. Mukamel and colleagues at the University of Rochester encourage policy initiatives to increase the effective use of quality-of-care report cards. Their findings were based on telephone interviews with the majority of MCOs licensed in New York State and analysis of their contracting data. They also studied the New York State Cardiac Surgery Reports for risk-adjusted mortality rate (RAMR), quality designation, and procedure volume for all cardiac surgeons.
For more information, see "Do quality report cards play a role in HMOs' contracting practices? Evidence from New York State," by Dr. Mukamel, Alvin I. Mushlin, M.D., Sc.M., David Weimer, Ph.D., and others, in the April 2000 Health Services Research 35, pp. 319-332.