Physician protest leads Blue Cross to delay care data

Reacting to pushback from doctors, BlueCross BlueShield of Tennessee will delay the planned April online publication of physician quality and cost information.

“I think it’s to their credit that they are backing off and trying to work out the kinks in the program,” said Chattanooga gynecologist Phyllis Miller, a past president of the Tennessee Medical Association.

BlueCross officials said they indefinitely postponed the March 3 deadline for doctors to submit corrections to their online profiles. Physicians said they are rife with inaccuracies.

“Because of the sensitivities around this (issue), we’re very intentionally making this a very open process where we’re very actively seeking input and involvement of physicians and consumers,” said Dr. David Moroney, the insurer’s chief medical officer.

BlueCross, the state’s largest health insurer, did not say whether the delay would be a matter of weeks or months.

Dr. Moroney said the insurer will fix as many problems with the physicians’ profiles as possible and make it easier for physicians to make other corrections.

BlueCross’ intent to publish cost and quality data is part of a national trend toward consumer-directed health care, which emphasizes giving patients more information to help them make educated health care decisions. Insurers Cigna and United Healthcare also began to publish physician information in this market a couple of years ago.

The physician information BlueCross plans to publish includes costs of specific procedures and evaluations of a doctor’s use of screening tests.

BlueCross officials acknowledge that the claims data used to compile the information is limited and does not include any detailed clinical information, as would a paper or electronic medical record.

The claims data also does not always reveal patient conditions that would make a screening unnecessary or impossible, doctors said. The ratings can’t account for patients refusing to comply with doctors’ orders to get tests, they noted.

“The basic premise is flawed, but yet it’s happening nationwide and everyone just assumes that the data is valid,” said Dr. Pete Kelley, medical director of business operations for University Surgical Associates.

Dr. Joseph Cofer, surgery program director for the University of Tennessee College of Medicine in Chattanooga, said meaningful quality comparisons of doctors must come from a more comprehensive medical database that has a statistically significant sample size and is adjusted to consider patients’ risk factors.

A program led by the America College of Surgery uses medical records data to compile detailed quality information for participating hospitals, including Erlanger, for internal hospital use, Dr. Cofer said.

“It’s truly comparing apples to apples,” he said.

Doctors insist they support publishing quality data if it is meaningful.

“Most of us do a pretty darn good job,” Dr. Kelley said. “We wish there was some way we could really document that and prove it, but it’s just not as simple as the insurance companies would have you believe.”

WHAT’S HAPPENED

BlueCross BlueShield of Tennessee wants to publish physician quality and cost information on its Web site in response to demands from consumers and business coalitions for better information about health care services.

Doctors last month told BlueCross that the information to be posted is misleading and in many cases inaccurate. The insurer said at the time that the company would address those concerns but still planned to make the information available to the public in April.

Now BlueCross has delayed the release date indefinitely.

The information-sharing program was not meant to be announced publicly until all the kinks were worked out, BlueCross spokesman Scott Wilson said.

“You’re kind of seeing all of this that would normally still have been behind the scenes. This cake was still baking,” he said.