Regence halts network opposed by Washington state doctors

Physicians and the health plan intend to collaborate on quality measures, but the defamation portion of the doctors' lawsuit against the insurer will continue.

By Amy Lynn Sorrel — Posted Dec. 25, 2006

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Physicians are celebrating an answer to their call for better quality improvement programs after Regence BlueShield announced this month that it would drop its new performance-based network in Washington state.

But that is only the first step, physicians say, toward making sure the measures that insurers use to rate physician quality are fair and do not get in the way of the physician-patient relationship.

Regence's announcement came less than a week after the American Medical Association/State Medical Societies Litigation Center joined the Washington State Medical Assn. in its lawsuit to stop the health plan from implementing its Select Network.

Doctors said the network, which graded physicians according to quality and cost efficiency, was based on inaccurate information gleaned from outdated claims data.

The WSMA sued Regence in September, claiming that the health plan defamed physicians when it told thousands of patients that their doctors did not meet the "quality and efficiency" standards to be included in the new network.

About 500 doctors were excluded from the plan set up for 8,000 patients who are members of the Society of Professional Engineering Employees in Aerospace.

"Patients' choice of a physician must not be influenced by a health insurer's mistaken assumption that low cost is the only acceptable measure of quality care," said AMA President William G. Plested III, MD.

Dr. Plested said getting involved in the lawsuit is the first test of the Association's plan that was adopted at its Interim Meeting in November to counter insurers' use of unproven efficiency criteria to compare physician performance.

The House of Delegates voted to push health plans to disclose the measures they use to judge physicians so that doctors could ensure that the plans' judgments are not driven by economic criteria.

The recently adopted policy also calls for organized medicine to work to prevent unfair quality measures from jeopardizing access to care and to explore legal actions to address economic profiling.

WSMA President W. Hugh Maloney, MD, said, "True quality improvement programs need the active involvement of physicians."

The WSMA plans to continue with the defamation portion of its lawsuit, he said. But the state's physicians want to collaborate with Regence to develop fair and appropriate quality measures to ensure that patients and doctors aren't harmed in the future if the health plan chooses to go forward with the network, Dr. Maloney added.

Regence spokesman Charlie Fleet said the company shares the same goal.

"There are a variety of metrics used, and we want to work collectively to develop measures that are meaningful, but are also setting the best possible standard," he said. Fleet said Regence's decision to drop the network was not related to the lawsuit.

The insurer initially responded to doctors' concerns by delaying the network's implementation by one year, until July 1, 2007. Fleet said the claims data Regence used to develop the program was not wrong and that it was based on information that doctors provided the insurer.

"We want to use cost and quality data measurements to inform consumers and providers of where they stand so consumers can make good choices," he said. "But the way this particular network was structured was not going to achieve our objectives."

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