California physicians sue over quality ratings

Physician ratings process needs transparency

The lawsuit is the most recent complaint organized medicine has made about health insurers' quality and cost rating, tiering and quality designation programs. Published studies have shown that research has supported physicians' assertions that these programs are inaccurate and potentially misleading, though the plans say they are based on firm, solid evidence.

The CMA says the Blue Ribbon program, which premiered June 1, is based on faulty data and doesn't accurately represent the quality of physicians' care.

"While Blue Shield of California has touted its Blue Ribbon Recognition Program as identifying physicians in California supposedly providing superior medical care to Blue Shield of California enrollees, in reality, it is an economic profiling scheme that inaccurately and unfairly rates [physicians] through the use of inherently flawed methodology," the lawsuit says.

There are many reasons to object to "quality reporting".  First, they are not measuring quality but rather pieces of quality.  The pieces usually refer to measures on the management of some common diseases (e.g., diabetes mellitus, CHF, hypertension).  Second, the measures come from administrative data rather than from evaluating actually patient care.  The measures often ignore patient characteristics, yet patient characteristics make a difference.  Third, the measures are statistically unstable. 

The "quality" movement represents a desire to measure physicians, a desire that reflects an unhealthy obsession in our society.  I suggest these older rants:

More on performance measures

Our obsession with measurement

This issue should rank in the top 3 problems of medical practice today.  The "train that has left the station" is a wreck.  I will not stop my campaign against this lunacy. 

Bravo to the California Medical Association.  I hope that this trial will slow down the train and perhaps even derail it.  They are not measuring quality, they are measuring something and they claim:

The AMA and state medical societies, including California, have called for insurers to publicly document the accuracy of their physician cost profiling.

Insurers, which have generally defended quality ratings as imperfect but better than nothing, said they want to work with physicians to improve rating programs.

In April 2008, Blue Shield was among the health plans that signed on to a Patient Charter for Physician Performance Measurement, Reporting and Tiering, drafted by the Consumer-Purchaser Disclosure Project, a group of businesses and consumers who advocate for transparency and meaningful quality information. The insurers pledged to use agreed-upon, evidence-based standard quality measures rather than cost data to rate physicians.

and

Major health plans and America's Health Insurance Plans, the plans' trade organization, have responded to that letter by saying that their programs are carefully established, that they believe in getting accurate results, and that they are qualified by National Committee for Quality Assurance's Physician-Hospital Quality Program, which certifies physician-profiling programs. However, the fact remains that RAND and others have found significant errors in multiple studies. A transparent system would resolve the matter concretely.

It's in everyone's interests that the ratings be correct. Instead, independent research has revealed problems, and the rating process largely remains a mystery — hardly a confidence-building profile of a system that presumes to give guidance to patients and pass judgment on doctors.

I opine that they are all on a fool's mission.  Quit trying to take shortcuts.  We cannot measure quality through proxies.  Evaluating quality is very complex, and not an actuarial task.