Texas Medical Association physician leaders and staff have worked for the past two years to win concessions from Blue Cross and Blue Shield of Texas (BCBSTX) to make its physician-rating program fair to doctors and useful to patients.
Much of that effort has involved modifying the company's BlueCompare rating tool, which is based on BCBSTX claims data and includes "affordability" and evidence-based measures information about physicians in the BlueChoice® and BlueChoice Solutions networks. Blue Cross says it's intended only to provide information and help patients select a physician.
What Do the Ratings Mean? | My Ratings are Wrong | What Has TMA Done to Fix This? | How to Improve My Practice
What Do the Ratings Mean? Where Did They Get the Data?
Contact information for local Professional Provider Network
My Ratings are Wrong; What Can I Do About Them?
Blue Cross has published a comprehensive document on how to request a formal review of your ratings. We urge you to read that document carefully, and remember these two key points:
- You must send your request in writing to your local Professional Provider Network office at the address specified in your letter from Blue Cross
- Requests received on or before April 21, 2008 , will be completed in time for any changes to be included in the BlueCompare annual update.
I am Really Upset About This; What has TMA Done to Fix This?
You are not alone. Physicians across the state have complained to TMA about these rating systems. TMA has worked for two years to win concessions from Blue Cross that make BlueCompare ratings more fair to physicians and more useful for patients.
- Worse Than the BCS: TMA Causes Improvements to Blue Cross Ratings (Texas Medicine, Jan. 2008)
- TMA continues to work hard to improve these rating systems. But we can't do it without your help. Please take a few moments to complete our feedback form to let us know why you believe your ratings are wrong.
- Among the changes Blue Cross agreed to are these:
- The number of clinical indicators will be limited to 18, all of which must have a strong source of evidence-based recommendation and recognition by a a national organization;
- Measures must be meaningful to patient care and have the potential to improve quality of care;
- Measures can be extracted from administrative data (e.g. eligibility, medical and pharmacy claims);
- Only light- or dark-blue ribbons will be assigned (a dark-blue ribbon for outstanding performance compared with peers and a light-blue ribbon for commendable performance compared with peers);
- It will be clearly stated if a specialty is not measured or if there is not enough data;
- A review process will be implemented that allows physicians to respond to their ratings before they are made public;
- Physicians may opt out of having their ribbon designation displayed on the Blue Cross Web site in 2008, and it will be clearly stated that the physician voluntarily declined; http://www.bcbstx.com/provider/pdf/opt_out_08.pdf ; and
- Blue Cross will retool how it communicates BlueCompare ratings to network physicians.
I Want to Improve How My Practice Performs; What Can I Do?
TMA members may access a wide array of services - some free, some fee-for-service - to help improve performance. The TMA Performance Improvement Resource Center online includes links to those services as well as tools and resources to help you assess your practice and devise a performance improvement plan.
Last Updated On
April 01, 2011