MA physician group files suit over rankings

The Massachusetts Medical Society has filed suit to stop a scheme under which doctors are ranked using cost and quality metrics by health plans working with an agency overseeing health insurance plans for public employees. The MMS says that the Group Insurance Commission (GIC), which works with thousands of state and local employees, defamed doctors that it arbitrarily ranked lower, and defrauded patients who pay higher co-payments based on their doctor's ranking.

The medical society had worked with the GIC for four years to improve its methods, and concedes that the agency made some changes. However, it still ranks individual physicians "using inaccurate, unreliable, and invalid tools and data," according to Dr. Bruce Auerbach, MMS's president.

To compile its individual physician rankings, the GIC runs an analysis on a claims database drawn from six insurance companies. However, the MMS says this approach has many flaws, including that it penalizes doctors that take on complex, expensive cases. Also, the data itself may reflect, for example, full expenses for cases in which a doctor read a chart but didn't participate in care, skewing the individual's cost results dramatically.

To learn more about the dispute:
- read this article from The Boston Globe

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