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Health Plan Doctor Profiles Inaccurate, Physician Groups Say

Cheryl Clark, for HealthLeaders Media, July 20, 2010

The complaint, signed by the AMA and 46 state medical societies, says that a physician can score well with one health plan, but based on similar information, score poorly on another, calling it a "Rube Goldbergesque" system to assess physician efficiency that must be changed.

"Some physicians have even been placed in three different efficiency tiers by three different insurers based on calculations using the same data," the letter said. "These inaccurate reports and erroneous physician assignments not only have the potential to harm patients and physicians, but they diver scarce resources from meaningful efforts to help physicians evaluate and address unwarranted variation in healthcare delivery."

The physicians' complaint echoes one expressed three months ago by the California Medical Association specifically about Blue Cross Blue Shield of California, which the CMA says used a rating system that misleads patients.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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