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May 21, 2010 On June 1 Blue Shield of California will start publishing on its website which doctors in its network score above average in eight healthcare categories. Blue Shield calls this a groundbreaking healthcare quality transparency initiative that the marketplace is demanding. The California Medical Association (CMA), which had been working with Blue Shield and others on the initiative for the past two years, pulled out of the initiative working group in April alleging that the process for collecting the data is flawed and that it results in “gross inaccuracies.” Michael-Anne Browne, Medical Director for Quality with Blue Shield, said the door is always open for CMA to return to the table. But CMA representatives left the table because they felt there was not a good faith effort by the other side to negotiate, said Andrew LaMar, CMA spokesman. “The initiative’s governing board, which is dominated by insurers, has chosen to ignore physicians’ grave concerns about this inaccurate rating system,” stated Brennen Cassidy, M.D., and president of CMA in a press release. The Blue Ribbon Recognition Program uses claims-based data on 13,000 physicians and information from those physicians themselves to measure their performance in eight areas, breast cancer, colorectal cancer, cervical cancer, cardiovascular disease, coronary artery disease and three areas for diabetic patients. The bulk of the data collected is based around preventive tests like mammograms and LDL tests and tests for maintaining the health of patients with diseases like diabetes. While CMA refers to the initiative as a rating system, Blue Shield calls it a recognition program in which Blue Shield doctors who score above average in any of the eight categories will get a blue ribbon icon next to their profiles on Blue Shield’s website. Browne says Blue Shield is trying to provide credible evidence-based quality information on physicians’ patient care. Currently consumers are relying on “social media,” like Yelp, which publishes user reviews. And those tend to be extreme reviews either from consumers who are very angry about the service they have received or very happy about it, Browne said. The CMA Board of Trustees supports the concept of CMA collaborating with payers on an alternative quality initiative program that would motivate physicians to improve patient care, CMA stated in a press release. But under the current Blue Shield program Blue Shield is making ”sweeping generalizations,” said CMA’s Andrew LaMar. “Publishing erroneous information will only serve to confuse patients, increase costs and unjustly destroy the reputations of many fine doctors,” said CMA president Cassidy. Blue Shield is working with the Pacific Business Group on Health (PBGH), a coalition of 50 purchasers of healthcare plans. These businesses include heavy hitters like Aerojet, Bechtel, Boeing Co., CalPERS, The Walt Disney Co. Safeway Inc. and General Electric Co. A multi-stakeholder initiative called the California Physician Performance Initiative (CPPI), which includes physician organizations, health plans, purchasers, consumers and health data experts, collected the claims data from more than five million patients and 63,000 physicians and used that to determine the physician performance results. In order for a doctor to obtain a blue ribbon in a certain specialty area, that doctor would have to have about 30 patients with the diagnosis in that specialty area, Browne said. CMA created a Quality Technical Advisory Committee made up of CMA physicians and this committee concluded that the CPPI goal is inconsistent with Blue Shield’s performance evaluation system. In an April 15 letter to Blue Shield CMA states that because physicians will be held accountable for patients who do not comply with physician recommendations for certain tests, some physicians may opt to drop non-compliant patients. And CMA states that some of the data collected is problematic. For instance one doctor was penalized for not ordering a cervical cancer test for a patient who had had a hysterectomy. But doctors are sent the information that is going to be included in their performance evaluation and given the chance to correct such inaccuracies, Browne said. LaMar of CMA in concerned that many doctors are not up to speed on Blue Shield’s plans. “Honestly until they post them (the performance results), I don’t think a lot of them (physicians) will be paying much attention,” LaMar said. But when the results are posted many patients will look at those results and make decisions about their doctors on those results alone, he added. Blue Shield plans to send out report cards to doctors this summer based on the 2009 data and at the end of this year or in early 2011 hopes to update the data. Organizations that support Blue Shield’s initiative include The American Association of Retired Persons, the California Public Employees Retirement System, The Service Employees International Union (SEIU) and the California Healthcare Coalition, among others. “This will help bring greater transparency to the health care delivery system, while encouraging accountability and higher quality in physician performance,” said Barbara Decker director of benefits for Southern California Edison, a member of PBGH, in a Blue Shield press release. CMA is still hoping there is time for Blue Shield to reconsider its plans to launch the initiative in June. LaMar said it is premature to say what action CMA would take if the initiative is launched as it stands now. “We’re assessing all of our options,” he said.
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