Tenn. Blues reboots physician rating program

A retooled physician rating program became available to nearly 2 million BlueCross BlueShield of Tennessee members in September.

The Tennessee Medical Assn. still has concerns, said Russ Miller, senior vice president. But he said the design is improved over the one that rolled out in March and was put on hold.

TMA has not formally endorsed or supported the program. Members met with BlueCross and served on a Physician Advisory Panel that helped design the ratings system, Miller said.

At a fundamental level, physicians still aren't happy ratings are based on claims data, which come with inherent limitations, Miller said. The TMA would also like it to be simpler for doctors to correct bad information.

Currently doctors can review the records that contribute to their scores, but it falls to them or their staffs to find evidence to correct any errors. "We feel the administrative burden shouldn't be on the people being rated," Miller said.

Physician ratings programs elsewhere also have been canceled or changed in reaction to physician complaints. Lawsuits brought by the AMA and other physicians groups have also delayed and blocked insurers from adopting what physicians see as unfair ranking, tiering and pay-for-performance programs.

Late last year, New York Attorney General Andrew Cuomo pushed the state's largest insurers to adopt standards for accuracy and transparency in their physician rating programs.

Earlier this year the AMA was among the early supporters of the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs, drafted by the Consumer-Purchaser Disclosure Project, a coalition of consumer groups and businesses. The charter called for independent standards for physician quality and cost reporting. BlueCross BlueShield of Tennessee was among the insurers to sign on.

The BlueCross Physician Transparency Program now rates about 4,000 physicians, mostly obstetricians and internists, on their "appropriate use" of eight tests; screening for Chlamydia, nephropathy, and colorectal, breast and cervical cancers, plus checking retinal health and monitoring hemoglobin A1c levels and LDL cholesterol in diabetic patients.

All physicians have cost profiles that compare with the state median.

BlueCross materials indicate changes made to the program include: removing hospital-based physicians, increasing the threshold for quality ratings, and extending the time physicians have to review their information. The program also has added language acknowledging the limitations of administrative data and encouraged patients to talk to their doctors.

"The program is stronger now for having postponed," Tennessee Blues spokesman Scott Wilson said. No time line has been set for expansion.