The Seattle Times reported on how Regence BlueShield, "one of the state's largest health insurers" is implementing pay for performance (P4P). We just discussed some of the concerns physicians have that P4P may have perverse results.
The Times reported, "nearly 500 doctors have been dropped from a health plan run by Regence BlueShield, one of the state's largest health insurers, which has sent letters to some 8,000 patients contending that the doctors' 'quality and efficiency' didn't measure up." However, it is not clear how Regence rated the physicians. Dr Peter Dunbar, President of the Washington State Medical Association, noted "Regence has a black box," he said. "The individual physician has no idea what's being measured."
The Times reported, "Dr. Joe Gifford, chief medical officer for Regence, said the rating system looks at doctors' 'quality measures,' such as prescribing the appropriate medications for congestive heart failure or asthma." However, apparently the data it uses "is taken entirely from billing data." As we have noted earlier, such data does not include clinical information that would allow adequate control for disease severity and other patient characteristics that may affect both process and outcome measures. Also, it is frequently unreliable.
Finally, Dr Dunbar said, "I think there's little doubt [the ratings] are about cost."
The Medical Society is demanding that Regence suspend the system and apologize to physicians. Dunbar noted that telling patients that the plan dropping doctors from the plan because of poor "quality and efficiency" is "a pretty egregious thing to say about somebody in print. This is a very heavy-handed, crude message." But what did he expect from a large health care bureaucracy?
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