Blue Cross of California Announces New Quality Scorecard, Bonus Program for PPO Physicians
Blue Cross of California today announced plans to launch a quality scorecard program this fall and pay bonuses to physicians who meet "high standards of care," the Los Angeles Times reports. The voluntary program, part of a movement nationwide to hold providers more accountable for the quality and cost of care, will cover many of the 43,000 California physicians in Blue Cross' preferred provider organization, which insures four million members. The new program, which will expand on a bonus plan based on patient satisfaction for HMO doctors that Blue Cross launched last year, will encourage PPO physicians to "follow the industry's best practices in the treatment and preventive care of patients." Under the program, each physician will receive a scorecard based on 16 clinical measures "accepted as high quality care," such as childhood vaccinations; breast, cervical and colorectal cancer tests; and management of chronic conditions. The scorecard also will include other measures, such as board certification, acceptance of new patients and "appropriate" prescription of generic treatments. Physicians will have the ability to view their scores online and compare them against an average of other doctors in their specialty, as well as a target score. However, doctors will not have access to the scores of other individual physicians, and Blue Cross PPO members will not have access to the scores "initially." Blue Cross officials said that the health insurer will pay bonuses to doctors of up to $5,000 per year and that the bonuses will not affect current reimbursement rates. Blue Cross officials estimate that the program will cost $1.1 million over three years. Dr. Woodrow Myers, chief medical officer at Blue Cross, said that the scorecards will provide "incentive" for physicians to "elevate their game," the Times reports.
Blue Cross this week will send notices about the program to 15,000 PPO physicians. Dr. Robert Margolis, CEO of Healthcare Partners Medical Group, called the program a "watershed event." He said, "My guess is that other PPOs will latch on to this to see if this is a way to improve care." However, some doctors and medical groups said that the bonuses in the program "may not be enough to stimulate significant change" in physician practices and raised concerns that Blue Cross may use the program to "extract lower reimbursement rates." A spokesperson for the California Medical Association also criticized the program, which he called a "marketing ploy" developed to attract new members in the open enrollment period (Lee, Los Angeles Times, 10/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.