Physician ratings

August 8, 2008

A long-delayed plan by Tennessee’s largest health insurer to furnish its customers with measures of network doctors’ quality and costs has drawn fire from the state’s top physicians group, but is on track to debut in September.

A long-delayed plan by Tennessee’s largest health insurer to furnish its customers with measures of network doctors’ quality and costs has drawn fire from the state’s top physicians group, but is on track to debut in September.

As part of a statewide “transparency” initiative, Blue Cross Blue Shield (BCBS) of Tennessee plans to launch an online tool on Sept. 15 that lists individual physicians’ average prices for treatment for conditions such as ear infections and nasal congestion.

Additionally, the tool will use claims data to rate physicians based on eight “quality measures” prescribed by the National Committee for Quality Assurance’s Health Effectiveness Data and Information Set (HEDIS), a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

The rise of high-deductible plans in which patients must shoulder much of the initial cost of health care was the impetus for the program, says Scott Wilson, a spokesman for BCBS of Tennessee. Further, many of the company’s competitors are embarking on similar initiatives, so BCBS of Tennessee felt compelled to do the same.

BCBS of Tennessee had originally planned to release the cost and performance measurement system in April, but ran into stiff opposition from the state’s doctors.

Causing ‘anxiety’
The quality measure in BCBS of Tennessee’s plan has caused “a lot of anxiety” to many of the company’s network physicians, says Russ Miller, senior vice president of communications at the Tennessee Medical Association (TMA).

“When you get down to it, someone else is publishing information on you saying whether you’re good or not,” Miller says of the plan.

TMA’s biggest beef with the program is that it relies only on claims data to measure quality. Basing physician quality rankings on claims data is “a flawed methodology and is misleading to the public,” the group says in a position paper.

Wilson says BCBS doesn’t have access to patients’ medical records, so claims data is the next best option.

Physicians in BCBS of Tennessee’s network have until Aug. 29 to review, comment on, and add, data to the system before its Sept. 15 debut to the public.