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Doctors Rated but Can't Get a Second Opinion
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Last fall, Schiesser joined five other doctors and the Washington State Medical Association in suing Regence BlueShield, claiming defamation and deceptive business practices after the health plan told participating members that they no longer had access to about 500 doctors because the doctors did not meet the insurer's quality and efficiency standards.
Regence spokesman Charlie Fleet said that because of the lawsuit, the company could not comment on the data issue. He did say, however, that the data were "provided from the physicians themselves."
In December, Regence abandoned its plan.
Doctors critical of ratings systems say they are held accountable for whether patients exercise, take their medications or follow their prescribed regimens.
Berkenwald, the Massachusetts internist, said he was pushed from Health New England's top 10 percent of physicians into its second tier because several of his female patients did not get the mammograms or Pap smears he prescribed.
But Berkenwald received a top-tier rating by several other insurers participating in the state's Clinical Performance Improvement Initiative because the health plans use different cut-points for determining who falls into which tier.
Disparate ratings can confuse patients and cause turbulence in group practices.
When Elizabeth Trobaugh of Amherst, Mass., had a tick bite last fall and her family doctor was not available, she saw her doctor's partner, who had a lower rating. Trobaugh was upset when she was charged a $10 higher co-pay. "Why should I be penalized for going to this person's partner?"
Despite its flaws, proponents say the systems encourage much-needed quality and cost control.
Dolores Mitchell, executive director of the Massachusetts Group Insurance Commission, which launched its physician-rating program four years ago, said she's heard doctors' complaints about errors. But at $1 billion in annual spending on health care, she said, improving performance and efficiency is crucial.
"The data may not be perfect," she said. "But they're better than any data that we've had before."
Staff researcher Richard Drezen contributed to this report.
