Press Release: TMA to Blue Cross: “Halt Misleading Rating Program”

The nation’s largest state medical society today demanded that Blue Cross and Blue Shield of Texas close down its faulty new doctor-rating system immediately.

“The new BlueCompare program is the latest insurance industry effort to put profit margins ahead of patient care,” said Ladon W. Homer, MD, president of the Texas Medical Association. “Instead of educating patients on where to find quality medical care, BlueCompare will further confuse Texans who are lost in the health care maze.”

Blue Cross announced last week that it will make BlueCompare available through its Web site on Jan. 1. TMA is appointing a body of practicing physicians and health care quality experts to fully evaluate the program. But TMA called on Blue Cross to halt the program immediately after a preliminary analysis found significant errors in how data are collected, processed, and reported.

One of the biggest problems with BlueCompare, Dr. Homer said, is that it uses health care bills and insurance claims, rather than the patients’ actual medical records, to evaluate the quality of care physicians are providing.

“You can no more tell from looking at a claim form that good medical care was provided than you can tell from looking at a restaurant bill that good food was served,” Dr. Homer said.

TMA is extremely concerned that the physician ratings Blue Cross plans to post on the Internet will further perplex patients. The system awards blue ribbons to those ranked doctors who fall into the top 60 percent of its questionable quality rankings. It brands with a gray ribbon those physicians ranked in the bottom 40 percent, as well as those physicians for whom it doesn’t have enough claim forms to rate and those who practice in specialties for which Blue Cross has no rating system.

“What is a patient to think if his or her physician falls into that great, murky gray ranking?” Dr. Homer asked. “This definitely can damage the trust and confidence patients rightly have in their chosen physicians.”

TMA is collecting and categorizing complaints from physicians who see BlueCompare as an inaccurate and unscientific way to evaluate the quality of care they provide to their patients.

“If Blue Cross and the rest of the health insurance industry are so concerned about so-called ‘transparency,’ we suggest that they start by cleaning the windows in their own houses,” Dr. Homer said. “Insurance companies must stop hiding away the critical pieces of information that employers and their workers need to know about which physicians are and are not on their networks, what their plans actually cover, and where their premium dollars actually go.”

TMA’s 2007 legislative agenda to combat health insurance abuse includes:

> Requiring health plans to develop comprehensive physician networks for patients;
> Requiring health plans to fully disclose to patients what types of physicians are not on their networks;
> Opposing all forms of physician-rating schemes that do not accurately assess high-quality, cost-effective care;
> Encouraging the use of smart cards to allow real-time access to important medical and coverage information that can be retrieved when patients present for both routine and emergency care; and
> Standardizing managed care contracts for physicians to protect patients from contract provisions that may pit economic incentives for the physician against quality care for the patient.

TMA is the largest state medical society in the nation, representing more than 41,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.