Doctors sue Blue Shield over ratings system

The California Medical Association is suing Blue Shield of California over an online physician rating system it alleges is inaccurate and could harm doctors' reputations, the Sacramento Business Journal reports.

The medical association's class action lawsuit seeks a court order to stop the program which began on June 1 and tell the public of its shortcomings. CMA alleges that ratings do not take into consideration information from patient medical charts, patient outcomes and previous treatment, because the program draws from only a few years of claims data from five insurance products sold by three large health plans, Blue Shield of California, Anthem Blue Cross and UnitedHealthCare, reports the Los Angeles Times.

The Blue Ribbon Recognition Program purportedly posts blue ribbons next to names of physicians on its website who have met certain standards of care, the Times reports. It recognizes doctors who scored above average in up to eight measures in preventive screening, diabetes and other categories, according to the Sacramento Business Journal. 

The suit says Blue Shield steers patients to cheaper doctors and fails to give doctors an opportunity to correct errors in ratings.

Blue Shield officials defended the ratings program, saying their website offers a disclaimer that the ratings are just one measure of physician quality. Dr. Michael-Anne Browne, Blue Shields Medical Director for Quality told the Times that no cost data is used to create the ratings.
And physicians were given ample opportunity to review, and if necessary, submit corrections to their reports, Johnny Wong, spokesman with Blue Shield of California told FierceHealthPayer.

Blue Shield developed the system with the Pacific Business Group on Health, a coalition of 50 purchasers that participates in the California Healthcare Reporting Initiative, a collaborative of purchasers, consumers, health plans and doctors.
To learn more:
- read the Sacramento Business Journal article
- here's the Los Angeles Times article 

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