Texas Attorney General Ends Investigation Of BCBS Physician-Rating Program

Main Category: Primary Care / General Practice
Also Included In: Health Insurance / Medical Insurance
Article Date: 16 Apr 2009 - 5:00 PDT

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The office of Texas Attorney General Gregg Abbott (R) on Friday said it ended an investigation into the physician-rating program of Blue Cross and Blue Shield of Texas and reached an agreement that the insurer will no longer use claims data to rank doctors, the Dallas Morning News reports. All major insurers operating in Texas use systems to rate doctors, but while these systems are seen as a benefit to members seeking better price and transparency in quality, they also can be "stumbling blocks in the payer-provider relationship," according to the Morning News. Doctors have expressed concerns that insurers create these ratings based solely on bills, without discussing the care delivered with doctors, and that physicians receive poorer ratings when patients fail to comply with their orders or when an insurer makes an error.

Under the agreement, BCBS will stop using claims data to measure the affordability of a physician's practice, a calculation that involves all steps taken and resources used during a visit or procedure. The firm still will use claims data to measure doctors' compliance with certain best practices. BCBS Texas President Darren Rodgers said, "We discontinued the use of certain affordability indicators voluntarily last July for a variety of reasons," adding, "We'll be introducing a revised indicator to assist members in determining relevant cost information for highly utilized services later this year."

Abbott said his office also resolved a probe into BCBS' alleged practice of threatening to terminate contracts with physicians solely for referring patients to out-of-network specialists. Rodgers said, "We denied all of the allegations but have agreed to execute the (agreement) because this is not something we do today," adding, "So there is no impact to any current business practices." He added, "We changed the language to more clearly state that we believe physicians have the right to discuss all available treatment options" (Roberson, Dallas Morning News, 4/11).

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