Three Stars

When I get a letter from an insurance company the greeting is usually “Dear Provider,” since the same letter (usually bearing bad news) is sent to doctors, nurse-practitioners, physical therapists and social workers. The letter usually details how we “providers” will be paid less money or will face additional roadblocks in getting care for our patients.

I should have known that something was up when I received a letter addressed “Dear Physician.” The letter, from a major insurer, informed me that I received a 3 star designation for care – in fact, my score was 95%. I supposed that I should be flattered, but in actuality my score could have just as easily been 65%. I was being measured on the percentage of my patients that had received services such as mammograms.

I don’t have a mammogram machine in my office. Patients need to make another appointment at another office. I treat my patients as the grown women that they are and ask them to have a mammogram. I hand them a referral slip and hope that they will make an appointment. I remind the patient at almost every contact, but I cannot drag the patient to the mammography suite and hoist her breasts onto the machine. It's up to the patient to have a mammogram, not me.

Mammograms help find breast cancer. The jury is out if they actually save lives. They are inconvenient, uncomfortable and can be expensive (thank you to insurance companies that will weasel out of paying for services). I do think that they are a good idea and actively promote them.

So, this year I am a 3 star physician. From what I can see, my 2 star and 1 star colleagues are taking good care of their patients too.