California Medical Assn. withdraws from state physician-rating program

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The California Medical Association (CMA) has withdrawn from a Blue Shield of California initiative to rate doctor performances because, according to CMA, the ratings have “serious and disturbing flaws in how data is collected on physicians that result in gross inaccuracies.” Blue Shield of California intends to publish its ratings June 1.

According to Blue Shield of California, the healthcare quality transparency initiative, or “The Blue Ribbon Recognition Program,” will publicly recognize physicians who scored above average in up to eight measures, including preventive screening and diabetes, allowing the public to identify thousands of high-performing doctors online and to make more informed healthcare decisions.

The San Francisco-based business coalition Pacific Business Group on Health and nonprofit health plan Blue Shield of California came together through the California Cooperative Healthcare Reporting Initiative (CCHRI), a collaborative of healthcare purchasers, consumers, health plans and physicians to measure the performance of 13,000 high-volume physicians on evidence-based healthcare quality standards.

Beginning June 1, some of these physicians will have a blue ribbon icon added to their Blue Shield online profile, according to Blue Shield.

The performance results are drawn from data collected by the California Physician Performance Initiative (CPPI), a multi-stakeholder initiative run by physician organizations, health plans, purchasers, consumers and health data experts to measure and report on the performance of California's physicians. Started in 2006 and run by CCHRI, CPPI aggregates claims data covering more than 5 million patients and 63,000 physicians to generate a set of quality metrics.

"Publishing erroneous information will only serve to confuse patients, increase costs and unjustly destroy the reputations of many fine doctors," said Brennan Cassidy, MD, president of CMA. "We are happy to stand on the merits of our work, as long as it is assessed accurately and fairly, but this initiative is far, far short of achieving that goal. As physicians, we are proud of the work we do healing patients each and every day."

The Sacramento-based CMA said it worked for two years on the CCPI with other stakeholders but pulled out last week when Blue Shield of California planned to ignore doctors' input and publish rating data before fixing fundamental flaws in performance assessment.

CMA said that major problems include:

  • Confusion for patients, who may be unduly concerned if their physicians do not get a high rating or may be tempted to select a new doctor who has a high rating. Because the ratings will not accurately assess doctors' performances, it will cause unnecessary confusion and anxiety for patients.
  • More costs for payers and patients: To receive high ratings, physicians will have to compensate for flaws in the reporting system, meaning some may have to order tests or procedures that have already been done but are not captured in claims data.
  • Lack of relevant data collection: The ratings only capture patient data for physicians contracting with the insurer, but for a variety of reasons, patients may need to see a physician not affiliated with the health plan's network. None of the out-of-network care is reflected. For instance, in a Preferred Provider Organization setting, a patient may see an out-of-network, non-contracting OB/GYN for a pap smear and may not inform her regular in-network primary care physician of it. Under CPPI rules, the primary care physician would be penalized because there would be no pap smear claims data submitted to the health plan.
  • No consideration of the patient's role: The ratings do not take into account, at all, patient refusal of treatment. For instance, patients may opt not to have a procedure or treatment done because they are unemployed and have lost their health insurance, want to go against the doctor's recommendation or have other extenuating circumstances.