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.
Brown said the accusations were untrue and that the company followed industry best practices. For example, the scorecard uses three years of data, gave the physicians eight weeks to respond and then provided an extension. It also checks to see if other physicians have provided the service and includes that in the score.
The CMA expressed objections last April, when it withdrew its participation in a physician's advisory group.
"We think the physicians were given an ample opportunity to review," she said.
She added that the CMA is "trying to collect evidence of harm" caused by the scorecard. "But we still are not aware of any evidence of harm from our Blue Ribbon designation program."
Brown summed up that the company officials "agree this is not a complete or full method of assessing quality of care, but we think it's a good initial step."
The CMA complaint says the Blue Ribbon Recognition Program "also fails to provide adequate explanations and disclosures regarding the basis for its 'ratings' and the fact that not all physicians are even eligible to receive a blue ribbon."
Richard Stern, MD, a San Pablo cardiologist and a named plaintiff, called the program "a flawed process that requires hours of physician time to correct extremely inaccurate data. I found that my ratings report was inaccurate after spending significant time reviewing the report against my patient records."
Cassidy summed up that the Blue Shield rating system "can undercut the entire medical profession," and said it misleads patients. "The art and science of medicine is complicated, and any ratings system should reflect that complexity. This is not restaurant service."
See also:
Physicians Claim Doc Rating System is Misleading to Patients