Lawsuit in Washington
The Washington State Medical Association has filed a lawsuit against Regence BlueShield. The claim states the health plan defamed physicians when they told patients that physicians did not meet the quality standards needed to be included in their network.
The information came from claims data. This is a common source of information by the insurers, but it is very limited and rarely accurate or up to date. W. Hugh Maloney Jr., MD, WSMA president elect said “the information was not corroborated with patients; medical records and in many cases was based on information 4 years old.” He gave examples of a physician being given a low rating for not ordering mammograms on a patient with bilateral mastectomies, and another for not doing pap tests on a patient who had a total hysterectomy.
In a number of instances, “there was egregious misapplication of data that has affected physicians’ reputations, their livelihoods and their relationships with their patients”
The executive VP of Regence did not directly respond to the allegations and they have delayed the implementation of this program.
The buzz word of the times “Pay for Performance” is what this really has to do with. When you use garbage data as the source, there will be no way to get accurate results in the results. Who will this hurt financially? Once again, it will be physicians taking the impact.
We hope they win this lawsuit to put a little more accountability on the insurers before they can publish garbage data for physicians or hospitals.
The information came from claims data. This is a common source of information by the insurers, but it is very limited and rarely accurate or up to date. W. Hugh Maloney Jr., MD, WSMA president elect said “the information was not corroborated with patients; medical records and in many cases was based on information 4 years old.” He gave examples of a physician being given a low rating for not ordering mammograms on a patient with bilateral mastectomies, and another for not doing pap tests on a patient who had a total hysterectomy.
In a number of instances, “there was egregious misapplication of data that has affected physicians’ reputations, their livelihoods and their relationships with their patients”
The executive VP of Regence did not directly respond to the allegations and they have delayed the implementation of this program.
The buzz word of the times “Pay for Performance” is what this really has to do with. When you use garbage data as the source, there will be no way to get accurate results in the results. Who will this hurt financially? Once again, it will be physicians taking the impact.
We hope they win this lawsuit to put a little more accountability on the insurers before they can publish garbage data for physicians or hospitals.
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