The managed-care provider uses claims data to measure how the care provided by 600 local physicians it contracts with compare with national industry standards and each other.

NevadaCare launched physicians' profiles a few years ago and said it ramped up its analysis to provide patients with more information since they are making more of their care decisions.

"As you see more and more people moving toward consumer-directed health care, it's a great opportunity to educate the population about which provider groups are scoring well on their quality measures," NevadaCare Chief Executive and President Todd Meek said.

Medicare, Sierra Health Services Inc., PacifiCare Health Systems Inc. and several others are evaluating physicians' treatments of common medical conditions, but they are offering varying amounts of information to the public. Some payers link doctors' performances to their reimbursements.

A Nevada physicians' advocate says the measures have limitations and could mislead the public because the measures are designed to help the managed-care companies.

Meek agreed that his company also benefits from the profiles.

"Every time we have a group that is meeting the standards, (patients) getting the care they need, those providers actually have an overall lower cost to the plan," Meek said. "(It's) good preventive care."

Dr. Kenneth Osgood, medical director of NevadaCare, said the physicians are not ranked, but they can compare themselves to their peers and see their progress.

"The purpose is not to sever any relationships but to encourage the physician to look at what he or she is doing and if they are not doing as well as their peers, (to) change their practices," he said. "We don't want to use this as punitive."

NevadaCare measured 2004 claims data for 135,000 of its patients with diabetes, sore throats, upper-respiratory infections, acute ear infections, severe asthma and high blood pressure or other diseases that require taking diuretics. The company also measured whether women were appropriately screened for cervical cancer.

Using nationally recognized industry standards, NevadaCare looked at whether doctors administered the appropriate treatments and tests.

For example, the company looked at whether family practice doctors, pediatricians and internists measured diabetics' glucose control at least once a year through a hemoglobin A1C blood test.

NevadaCare found that 55 percent of the patients received appropriate monitoring, and 31 percent of the diabetic patients were screened for kidney problems using a urine test that measures protein, Osgood said.

Other findings by Osgood and his colleagues include:

• 85 percent of all children received the recommended treatment for ear infections and more than 90 percent of the children treated by a pediatrician did;

• 59 percent of all patients with runny noses and colds received proper treatment, which is to let the condition run its course without antibiotics;

• 39 percent with severe asthma received appropriate care;

• 15 percent of patients with sore throats were given throat cultures or rapid strep tests and;

• 25 percent of the female patients received appropriate cervical cancer screening.

"With some of the physicians, virtually all of their patients were properly screened," Osgood said. "With others, that's not the case."

Other medical measures will be evaluated down the road, Osgood said.

So far, physicians have given positive feedback about the profiles, he said.

NevadaCare, like other local managed-care providers, also tracks how often physicians order prescriptions, lab tests and X-rays and how frequently their patients are treated in emergency rooms, he said.

"Some doctors order a lot of things for the same disorders and the outcomes seem to be the same to the degree that we could measure," Osgood said. "There is a substantial variation between the number of tests and consultations they order. It's my sense, having been around for 40 years, that the issue is really individual practice styles and anxiety about litigation, but it's not about a need for thoroughness."

While physicians are not being punished for underperforming, they could receive fewer patient referrals from NevadaCare customer service representatives as a result of their care, he said.

NevadaCare is not linking doctors' performances to reimbursements or incentive pay, but the results could affect provider contracts for doctors who don't try to improve their care, Meek said.

"Physicians want to do well," Meek said. "For those folks who repeatedly will not deliver the level of care that is necessary, those folks will be removed from the contract."

Larry Matheis, executive director of the Nevada State Medical Association, said the quality standards could be useful to the public and physicians, but they are preliminary indicators.

"For the public and physicians, it's good to have more information than less, but it's also good to really view these with a big grain of salt," he said. "You get some that are real measures of something (and) some that are really not what they claim to be (and measure) how much does a doctors' patients cost insurers."

Managed-care companies, or health maintenance organizations, are evaluated by the federal government for the care they oversee so the companies measure physicians, Matheis said.

"They've turned lemons into lemonade by turning these requirements on HMOs to consumer guidance," Matheis said. "Somewhere down the road there are going to be ways to evaluate the quality of patient care provided by physicians (and) the value of insurance products, but we're still at a very early stage of having any qualitative systems that are meaningful."

Las Vegas-based Sierra Health Services Inc., through its managed-care plan Health Plan of Nevada, has been profiling physicians for nearly a decade on some level.

Scott Cassano, assistant vice president of Sierra's provider relations, said his company profiles its physicians and sends quarterly progress reports that show how doctors compare.

"We don't just do one type of model," he said. "We try to communicate with our providers a lot."

Sierra measures how many diabetics a provider treats and whether those patients are receiving the appropriate care.

"That we've seen a tremendous response to," Cassano said of those types of profiles.

He said some providers have asked Sierra to help them improve their care.

Sierra rewards providers who improve their care significantly through parties and pays increases in reimbursements to doctors who have high patient satisfaction scores, Cassano said.

Cypress, Calif.-based PacifiCare Health Systems Inc. also tracks physicians' treatment methods for the 180 doctors it contracts with in Nevada and sends them quarterly reports, PacifiCare spokeswoman Cheryl Randolph said.

In California, Oregon and Washington, PacifiCare makes the physician profiles publicly available, but there are no plans to do that in Nevada because there is only one physician group PacifiCare contracts with, she said.

Michelle Swafford covers health care and small business for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached by e-mail at swafford@lasvegassun.com or at (702) 259-2326.