On Friday, the California Medical Association filed a class-action lawsuit claiming that Blue Shield of California created an online physician rating program that potentially could harm doctors and their patients by promoting inaccurate information, the Sacramento Business Journal reports.
Background on Program
In June, Blue Shield launched the Blue Ribbon Recognition Program, which posts blue ribbon designations on its online physician directory next to the names of health care providers who meet certain standards for quality care in diabetes, preventive screening and other categories.
Blue Shield worked with the Pacific Business Group on Health to evaluate the doctors using data collected by the California Physician Performance Initiative. CPPI generates quality metrics by aggregating claims data covering more than five million patients and 63,000 physicians (Robertson, Sacramento Business Journal, 9/10).
Lawsuit Details
CMA's lawsuit, filed in Alameda County Superior Court, argues that Blue Shield's rating program:
- Does not include information from patient medical charts, patient outcomes and previous treatment;
- Relies on a few years of data from five insurance products sold by Blue Shield, Anthem Blue Cross and UnitedHealthcare (Hennessy-Fiske, Los Angeles Times, 9/11); and
- Does not provide doctors with an opportunity to correct potential errors in their ratings (Clark, HealthLeaders Media, 9/13).
CMA is seeking a court order to stop the program and inform state residents about its problems. The association also is seeking monetary relief and damages.
Blue Shield Response
In a statement, Blue Shield expressed disappointment that CMA decided to sue rather than collaborate on the program (Sacramento Business Journal, 9/10).
The insurer also said its website includes a disclaimer stating that the ratings are only one measure of physician quality (Los Angeles Times, 9/11).