Doctors don’t want to see the lists
used to set a liability standard, for ex- ample, for following or not following the recommendations, Dr. Strate says. Nor do they want them to add any complex- ity to physicians’ practices, when time al- ready is scarce and administrative costs are climbing. Physicians can’t have every office visit turn into what Dr. Strate described as a medical economics lesson, where every time the patient comes in, doctors have to go through the cost of every single option. That’s where health insurance plans can contribute, she says, by mak- ing information on patients’ out-of-pock- et costs more readily available. Physicians also are casting a sharp eye on insurers’ response to these lists. While the guidelines are not meant
to represent absolutes, doctors are con- cerned that payers, commercial or gov- ernment, could interpret them that way and use the language to refuse preautho- rization for certain tests or treatments or deny payment altogether. So far, no health plan has ventured
to do so, and the ABIM Foundation and professional medical organizations be- hind the lists are adamant that insurers shouldn’t use them that way. Nevertheless, it remains a concern. Dr. Strate likened the scenario to in-
appropriate efforts by insurers to use ad- ministrative claims data for quality and payment purposes, when that data does not tell the whole story. “If, for example, only half of your pa- tients who need mammograms get them, that doesn’t say you are a bad doctor. There may be other social or economic reasons patients did not do it. Every patient is unique. Quality care is about good clinical judgment, and nothing should supplant that. Period.” Dr. Cassel agrees and says that the campaign’s goal is not cookie-cutter medicine. “It’s the opposite. Every one of these treatment decisions needs to be made on an individual basis. But not ev- ery individual needs it.”
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