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Texas Blues plan suspends rating system -- for now

The plan reacted to physician pressure in suspending an effort to post doctor cost and quality ratings online. But that effort still might come back.

By Jonathan G. Bethely — Posted Jan. 15, 2007

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BlueCross BlueShield of Texas says it was just doing what employers and other constituents wanted when it created a new doctor-rating system called BlueCompare. But the health plan postponed the program's January launch after complaints came pouring into the Texas Medical Assn. about the method used to rank physicians.

The Blues plan is leaving open the possibility of instituting BlueCompare in the future, though it has given no timeline for when that might happen.

The plan says the online tool is a way for consumers to obtain cost and performance information for nearly 38,000 physicians in Texas. At issue is the fairness behind ranking physicians using health care bills and insurance claims, instead of using the patient's actual medical records to evaluate the quality of care that physicians provide.

"Because they feel they're under pressure, they released a program just to give them more clout with their businesses," said Ladon W. Homer, MD, president of the Texas Medical Assn. "This is nothing more than a marketing tactic on their part."

Similar arguments have been made against ratings systems by other state plans, including systems that would let patients pay less out of pocket to see highly rated physicians. In the Texas Blues' case, no special tiered network was set up to separate higher-rated physicians from lower-rated doctors.

BlueCompare's rating system would break physicians into three categories: more, average or less affordable. The system also would used colored ribbons to rank physicians on how well they practice "evidence-based medicine." Those deemed to perform well under that heading would have a blue ribbon next to their names. Those considered average would have a light-blue ribbon. Those considered less than average, or for whom data are not available, would have a grey ribbon.

Dr. Homer said the Texas Medical Assn. was assembling a panel to study BlueCompare and would recommend to the Blues plan how to fix the system so that physicians weren't unfairly placed into the lowest ranking category. The panel will have until the end of January to make its recommendations, and the health plan has agreed to listen at that time -- with the possibility of restarting the program.

"Physicians in Texas are angry," Dr. Homer said. "They will implement this program despite our efforts. It's just a matter of time. If they do implement it, I hope they will take our recommendations, but I don't think they're going to."

Darren Rodgers, senior vice president of health care management for BlueCross BlueShield of Texas, said the health plan didn't want to publish negative information, but it recognizes physicians' concerns about the perception of being linked to a poor performing category based on the criteria that was initially used. "We understand that TMA has a constituency that needs to be educated, but we have a constituency too," Rodgers said. "Our employers have been supportive of this tool. We just need to tweak it to make it more palatable to the physician community. We have a long history with TMA. We are committed to working together."

Despite assurances from the Blues plan about working to resolve the issues surrounding BlueCompare, Dr. Homer said the medical association would explore all options, including legal courses of action, if the program is rolled out without major changes.

It wouldn't be the first time physicians used the courts to fight physician rating systems.

Last month, Regence BlueShield agreed to drop its performance-based network under the pressure of a lawsuit by physicians in Washington, the Washington State Medical Assn. and the AMA/State Medical Societies Litigation Center. Doctors said the network, which graded physicians according to quality and cost efficiency, was based on inaccurate information gathered from outdated claims data. Patients would have been given economic incentives to choose physicians in the so-called Select Network. But the lawsuit's libel and defamation claims -- based on letters Regence sent to patients saying their doctors did not meet the standards for the new network -- are still active.

The AMA House of Delegates voted at the Interim Meeting in November 2006 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.

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