Doctors slam Blue Shield's physician rating system: 'Serious and disturbing flaws'

A new physician-rating system co-created by Blue Shield of California and the Pacific Business Group on Heath (PBGH) set to go public June 1 has drawn the ire of the California Medical Association. The physician group withdrew from the initiative due to what it called "serious and disturbing flaws" with data collection that lead to "gross inaccuracies." 

The Blue Ribbon Recognition Program will highlight physicians who achieve high scores according to evidence-based quality standards. Out of 13,000 high-volume doctors in the state, those whose scores are "above average" based on data collected for up to eight measures by the California Physician Performance Initiative (CPPI) will have a blue ribbon icon placed next to their online Blue Shield profiles

Dustin Corcoran, CMA's leader, called the ratings "defective" for several reasons, including "lack of relevant data collection" and "no consideration for the patient's role," in a letter sent to Blue Shield President and CEO Bruce Bodaken and to California Cooperative Healthcare Reporting Initiative, which helped create the ratings system. 

"Under the current CPPI model, physicians are 100 percent accountable even if a patient refuses to adhere to recommended care," Corcoran wrote. "There are strong sentiments from physicians that they should not be penalized for something that is beyond their control as submitted by physicians who participated in CPPI....This may have the unintended consequence of creating a disincentive to care for non-compliant patients to avert negative CPPI scores."

Blue Shield Chief Medical Officer Meredith Mathews, MD, responded to Corcoran by pointing out that the CPPI project and Blue Shield aren't out to penalize doctors whose patients are non-compliant. "In fact Blue Shield's program does not penalize physicians at all, but simply provides positive public recognition for those who have sufficient volume to be credibly rated and have better results," Mathews wrote. He also pointed out that the claims data used is "widely accepted," specifically mentioning an endorsement by the National Quality Forum.

Perhaps not surprisingly, several consumer-oriented groups support the program. AARP California State President Jeannine English said that her organization sees publicizing doctor performance statistics as "empowering" to patients and that doing so encourages them to "take a more active role in their healthcare." California Health Care Coalition chairman Ken Stuart added that such measures "foster accountability and encourage physicians to meet or exceed national standards of care."

For more information:
- read this CMA news release, which includes the letter
- here's Blue Shield's response to the CMA
- read this joint release from Blue Shield of California and PBGH

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