Blue Shield Expected To Seek Dismissal of Case Against Rating System
Blue Shield of California is expected to ask an Alameda Superior Court judge to dismiss a lawsuit filed by the California Medical Association over the insurer's online physician rating system, California Watch reports.
In June, Blue Shield launched a program that posts ratings for hundreds of California physicians and health care groups on the health plan'sÂ website.
Blue Shield's scores were based on a variety of metrics, such as:
- Whether physicians conduct annual kidney function tests for patients with diabetes;
- Whether physicians prescribe drugs to patients with asthma; and
- Whether physicians prescribe generic medicines.
Before Blue Shield unveiled its online rating tool, CMA withdrew its participationÂ from the stakeholder input phase of the project. CMA said the rating system had "serious and disturbing flaws" because it:
- Does not account for care that patients might receive outside of Blue Shield's physician network;
- Fails to account for instances in which patients refuse care; and
- Might increase costs if physicians duplicate tests that are not included in the rating data.
In September, CMA filed a lawsuitÂ against Blue Shield, alleging that theÂ physician rating system looks at only one year of billing data and does not review medical records for individual patients.
Blue Shield's Response
Blue Shield has said that its online physician rating system is based on standard measures of quality care. The insurer said the system "does not consider cost and does not penalize physicians."
Blue Shield also said that physicians have received sufficient opportunity to review patient records and submit corrections to any problems with the data (Jewett, California Watch, 1/19).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.