CMA Sues Blue Shield Over Physician Rating System
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."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- MU Compliance Announcement Sparks Concern, Confusion
- New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care
- Scary Financial Challenges for 2014
- MGMA Urges 'End-to-End' ICD-10 Testing
- 1 in 5 CT Screenings for Lung Cancer Results in Overdiagnosis
- Telehealth Improves Patient Care in ICUs
- LifePoint Bolsters Presence in Michigan's Upper Peninsula
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- States Rejecting Medicaid Expansion Forgo Billions in Federal Funds
- Douglas Hawthorne—A Chance to Do Something Big