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CMA Sues Blue Shield Over Physician Rating System

Cheryl Clark, for HealthLeaders Media, September 13, 2010

The California Medical Association, which represents 35,000 doctors, says it has filed a class action lawsuit against Blue Shield for imposing an unfair and potentially harmful rating system, the Blue Ribbon Recognition Program.

"We believe by using and publicizing what is a faulty assessment of physicians, without adequate disclosures of the limitations and faults in the ratings, Blue Shield is both misleading the public and potentially damaging the reputations of thousands of doctors," said Brennan Cassidy, MD, president of the CMA.

He said that the practice of medicine is complicated, and any rating service should reflect that. "This is not restaurant service."

The lawsuit was filed in Alameda Superior Court and seeks injunctive and monetary relief.

Michael-Anne Brown, medical director for quality with Blue Shield of California, said she thinks the doctors "don't want a public scorecard."

"They're very uncomfortable with the notion of public reporting. But with healthcare reform, it's likely we'll have more and more transparency in healthcare, not less. Increased transparency will lead to better decision-making on the part of doctors and patients."

The scorecard in question involves Blue Shield's posting of blue ribbons on its website next to the names of doctors who have met certain care criteria standards.  But the CMA lawsuit says the scoring system is flawed.

 

 

  • There is no review of medical charts.
  • There is no evaluation of patient outcomes.
  • No checking to see if a patient received a procedure from another physician.
  • The scorecard uses only one year of claims data, when many tests and procedures are not required yearly.
  • The scorecard uses claims data for only five specific insurance products sold by the three largest health plans.
  • The insurance plan does not give physicians a fair opportunity to correct "numerous errors" in Blue Shield's assessment of them.
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    2 comments on "CMA Sues Blue Shield Over Physician Rating System"


    Steven Gwiazdowski (2/23/2011 at 11:26 PM)
    I disagree with Charlie's comments. Physicians take no issue with transparency or scoring systems. As a physician myself, I can tell you that we physicians have been "scored" our whole lives; college, medical school, internship, residency, fellowship and board certification. Where wer take humberage with the current systems as promulgated by BlueShield have no method of "risk adjustment." What this means is that if doctor A, who takes referrals for the most difficult cases no one else can handle is measured against Doctor B who gets overwhelmed by even the most rudimentary problems refers everything out....doctor A will look worse in the eyes of the public. This is not only misleading, it leads the public to the less capable physician! Claims data analaysis does not even begin to address this issue.

    Charlie Land (9/16/2010 at 1:29 PM)
    These doctor lobby groups sound like a broken record. The seek to discredit every form of performance ranking there is and fight to be held unaccountable, its selfish and shameful. Luckily third party sites like HealthcareReviews.com do no fall under the powers of these legal battles, as they tried and failed to shut them down unsuccessully already. The insurance companies have quite a battle on their hand, hopefully a comprimise will happen.