CMA Files Lawsuit Against Blue Shield for Launching Bogus Physician Rating System

Complaint filed alleges “Blue Ribbon” program may mislead the public and undermine physicians and patients by inaccurately and unfairly assessing doctors’ performance

Sacramento — The California Medical Association alleged in a lawsuit filed today that Blue Shield of California has launched an inaccurate physician rating program that is potentially harming doctors and their patients by spreading misinformation and failing to accurately assess patient care.

The complaint, filed in Alameda County Superior Court, alleges Blue Shield went public with the program in June despite being aware of certain material fundamental flaws. The suit seeks injunctive and monetary relief.

“As physicians, our No. 1 priority is our patients,” said Brennan Cassidy, MD, president of CMA. “We believe by using and publicizing what is a faulty assessment of physicians, without adequate disclosures of the limitations and faults in the ratings, Blue Shield is both misleading the public and potentially damaging the reputations of thousands of doctors.”

Blue Shield’s Blue Ribbon Recognition Program posts blue ribbons next to names of physicians on its web site that have met certain standard of care criteria. As the complaint points out in its allegations, the flaws in Blue Shield’s evaluation include:

• No review of medical charts.
• No evaluation of patient outcomes.
• No checking to see if a patient received a procedure from another physician.
• Only using one year of claims data, when many tests and procedures are not required yearly.
• Using claims data for only five specific insurance products sold by three large health plans.
• Not giving physicians a fair opportunity to correct the numerous errors in Blue Shield’s assessment of them.

The Blue Ribbon Recognition Program “also fails to provide adequate explanations and disclosures regarding the basis for its ‘ratings’ and the fact that not all physicians are even eligible to receive a blue ribbon,” the complaint alleges.

The class action suit names as plaintiffs Lisa Asta, MD, a Walnut Creek pediatrician, and Richard Stern, MD, a San Pablo cardiologist.

"This is a flawed process that requires hours of physician time to correct extremely inaccurate data," Stern said. "I found that my ratings report was inaccurate after spending significant time reviewing the report against my patient records."

“CMA believes that a defective ratings system can undercut the entire medical profession,” Cassidy added. “Not only does this take away from patient care, by forcing physicians to spend hours trying to correct the record, but it also misleads patients. The art and science of medicine is complicated, and any ratings system should reflect that complexity. This is not restaurant service.”

The suit alleges the ratings system amounts to an economic profiling scheme in which Blue Shield intends to direct patients to physicians who charge less. In doing so, the complaint asserts Blue Shield is potentially corrupting the sacrosanct physician-patient relationship.