Recently I received my “gap” report from our employee insurance plan and my latest physician report card. Now that I have worked through the 5 stages of grief, I’m ready to grapple with the numbers.
The Good
- I finally hit the HEDIS 75th percentile for the number of diabetic patients with a Hemoglobin A1C less than 9%. My percentage was parked in the 50’s for months. I knew that my diabetics were better controlled than that, but maybe I was in denial. Once I looked at the data and talked to our IT staff, we discovered that the list was incorrect. Rewriting the data collection rules increased my percentage by 30%. You have to make sure the data is correct.
The Bad
- Although I have sent multiple letters for 6 months, I still cannot get several patients to come in for Pap smears and breast exams. Do I need do call them repeatedly, drive to their homes, and beg them to come in? Perhaps their insurer, our hospital system, could put some of the patient’s skin in the game. Get all the preventive care you should and your premium goes down. Don’t get the care you should and your insurance premium goes up. Sounds fair to me.
The Ugly
- My cervical cancer screening rate is now less than 20%?! At least one outlier on my gap report doesn’t have a cervix. Once I find out how to do a Pap smear on a nonexistent cervix, I’ll let y’all know. We are being held responsible for errors in the insurers’ claims data. Expertise in data collection and interpretation is essential for a modern physician.
Troy Fiesinger is a family doctor in Sugar Land, Texas. He is interested in health policy, care for the underserved, medical educations, social media, and reinventing health care. Any opinions expressed here are his own.
Texas Family Doc 
I have same problem. It is especially galling that I’m dinged if no Pap in 2 years, when current USPTF recs are 3-5 years.
Agree 100%. It’s frustrating to practice evidence based medicine in keeping with current guidelines when insurers aren’t.