Blues Ranking Letters on the Way

Beginning mid-February, physicians may begin checking their mailboxes for letters from Blue Cross and Blue Shield of Texas (BCBSTX) containing doctors' latest ratings in the plan's BlueCompare quality and cost-efficiency assessment program. BCBSTX says it will publish those ratings, displayed as ribbons, in its web-based "Provider Finder" tool as of June 1.

The plan also will send information outlining a new "Physician Quality Measurement" (PQM) online ranking program set to launch some time later in 2013.The PQM initiative is part of a national effort by the Blue Cross and Blue Shield Association (BCBSA) to improve transparency for consumers when they shop for a doctor.  

Under the new program, each state's plan will rate physicians based on its choice among a pool of 20 set quality measures that BCBSA indicates will come from nationally endorsed quality measures of common conditions like asthma, back pain, diabetes, depression, and heart disease. BCBSTX says it will use the same measures for the new PQM as those used for BlueCompare, and the new program is meant to "enhance" the BlueCompare ratings by displaying the details of a doctor's measurement results for each quality metric.  

Patients searching online for a physician will see a physician's performance rating for each quality measure displayed as a star next to his or her name, in addition to a score comparing the doctor with local peer groups. Patients also can view an online description of the quality measures used to rate a physician. 

"Today's consumers are always looking for more information about physicians and quality health care," said Allan J. Chernov, MD, BCBSTX medical director for health care quality and policy. The PQM program supports patients' "healthcare decision-making, and promotes the collaboration of physicians, patients, health plans and employers in continuously improving the quality of care."  

TMA Director of Payment Advocacy Genevieve Davis said the association is working with BCBSTX to make sure the plan's program complies with a 2009 state law governing physician ranking and tiering programs. TMA won legislation that gives physicians the right to appeal their ranking or classification before a health insurance company publishes it or to opt out of a program completely. Plans also must involve actively practicing physicians in developing quality standards used. 

For physicians who choose to participate in a rating program, TMA wants to make sure they can truly review their quality data before Blue Cross posts it for all to see. On the other hand, messages indicating to patients that a physician has opted out should not be disparaging, Ms. Davis says. 

You can find information on physician rankings on the Physician Ranking page of the TMA website. The page includes "Basic Steps for Reviewing and Disputing Physician Rankings & Tierings," a two-page guide on how to appeal your ranking. 

Action, Dec. 4, 2012