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CMA Sues Blue Shield Over Physician Rating System

Cheryl Clark, for HealthLeaders Media, September 13, 2010

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


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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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.