Mass. BCBS to "tier" hospitals, MDs

Charging patients a higher copayment for more expensive prescription drugs is an established practice. Now, Blue Cross Blue Shield of Massachusetts is taking things a step further.  If their plans are approved by the state insurance authorities, BCBS will charge patients more if they go to prestigious, expensive hospitals or to hospitals and doctors with bad records. These hospitals will be ranked on "tier two," while the rest will be on the less expensive "tier one." The program is designed to stem rising healthcare costs. BCBS hopes patients will realize that higher cost care does not necessarily equal better outcomes, and that less expensive community hospitals can provide high quality care. Also, the program will steer patients away from doctors and hospitals with bad records that may increase medical costs in the long run.

As is usually the case with quality ranking programs, critics are wary about what data the insurer will used to rank doctors and hospitals. "For us, the measure of a good quality rating system is whether it's using real medical records and clinical data or whether it tries to figure out the track record by going through the billing record and trying to reconstruct a medical history," a spokesperson for the Massachusetts Hospital Association said. Critics also expressed concern that the tier ranking could play too large a role in contract negotiations between hospitals and BCBS. The proposed plan has yet to be reviewed by state regulators and will not be available until after Jan. 1, 2007.

- read this article about the BCBS plan from The Patriot Ledger

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