Paul Kulpa

After months of discussion with physicians, BlueCross BlueShield of Tennessee went live Monday with a Web site displaying physician quality ratings and cost data to its members.

The health insurer’s new Web feature — now accessible to the 2 million members BlueCross members in the state — draws information from doctors’ insurance claims and is meant to show how well doctors follow eight measures of performance, such as the regular use of eye screenings for diabetes patients and annual Pap smears for women. The physician profiles also show doctors’ cost information, BlueCross officials said.

“The reason why we’re doing this is because our employer groups and our members are asking for it,” said Paul Kulpa, product manager for consumer-directed products at BlueCross. “As we continue to shift toward ... higher deductible-type plans, there’s more of a need to have this cost and quality information available.”

Doctors here have broadly, and vocally, opposed the release of ratings based on this information, arguing that data drawn from billing records can be misleading and unfairly can damage a doctor’s reputation.

For example, billing records might not show that a female patient has had a hysterectomy in the past and therefore does not need an annual Pap smear, doctors pointed out.

Through Aug. 29, Tennessee doctors could use a “self-report” tool on BlueCross’ Web site to explain those kinds of situations on their physician profile, said Scott Wilson, BlueCross spokesman. At least 700 doctors submitted additions to their physician profiles using the tool during the physician response period, he said.

The process is time consuming for doctors, he acknowledged.

“Did it take effort? Yes. But our members — who are their patients — are demanding it,” Mr. Wilson said. “We live in a world where the consumer rules, and I think they (doctors) do, too. It’s just the changing health care landscape.”

Chattanooga and Hamilton County Medical Society officials said they appreciate BlueCross’ efforts to listen to doctors’ feedback. Both United Healthcare and Cigna Healthcare have similar physician-ratings programs online, but neither insurer met with medical society members to discuss the programs, said Dr. Vince Viscomi, president of the society.

“Very candidly, (BlueCross is) the only insurance company that has ever engaged the doctors in trying to make this as accurate as possible,” he said. “They’re really trying to do the best they can. ... (But) it’ll never be perfect.”

United’s physician rankings, posted on the insurer’s Web site, launched in late 2006 in Tennessee, and all doctors included on the site have received notification and can submit feedback, said Garland Scott, CEO for Mid-South United Healthcare, which serves Tennessee and Arkansas.

Cigna officials could not be reached for comment Monday.

CONSCIOUS OF COSTS

As patients bear more of the burden for health care costs, data on quality and pricing can help them make smarter — and more cost-conscious — health care decisions, BlueCross officials said.

Knoxville-based HealthCare 21 Business Coalition, a nonprofit member organization comprised of employer groups, encouraged BlueCross to provide this information to the public, said Jerry Burgess, president and chief executive officer of the coalition. The groups’ members and their employees are demanding more information to help them make better choices, Mr. Burgess said.

“When you’re shopping for anything, you want to know what’s the quality and what’s the cost,” he said.

But many doctors maintain that the limited nature of claims data can’t possibly give an accurate indication of a doctor’s competence.

Dr. Colleen Schmitt, a gastroenterologist with the Galen Medical Group in Chattanooga, said quality indicators can be valuable to patients, but BlueCross’ site has a number of weaknesses, such as the fact that it cannot account for patients’ noncompliance with doctors’ orders.

“We still do have some significant concerns about it,” she said. “We want to be sure the information patients are basing their decisions on is accurate information.”