Washington doctors sue Blues plan over performance standards

Physicians say Regence BlueShield gave them poor quality ratings using bad data. Regence says it uses professional standards and wants to collaborate on improvements.

By Amy Lynn Sorrel, AMNews staff. Oct. 16, 2006.

The Washington State Medical Assn. is suing Regence BlueShield, claiming the health plan defamed physicians when it told thousands of patients that their doctors didn't meet the "quality and efficiency" standards needed to be included in the insurer's new performance-based network.

As the national movement toward quality improvement gains ground, the lawsuit reflects doctors' push for more involvement in creating quality measures to ensure that they are fair and do not interfere with the doctor-patient relationship.

In the lawsuit filed Sept. 20 in King County Superior Court, the WSMA and five individual doctors claim that Regence's move to exclude 500 doctors from its Select Network was based on inaccurate and outdated information from claims data. They also say that the insurer breached its contract with physicians by arbitrarily dropping them from the network and telling patients they would have to find a new doctor.

Regence's new plan, announced in a letter to doctors and patients in May, affects about 8,000 patients who are members of the Society of Professional Engineering Employees in Aerospace.

"The problem is that there was flawed data and physicians did not have a chance to react or use the appropriate information to improve it," said internist W. Hugh Maloney Jr., MD, WSMA president-elect. The information that Regence used was not corroborated with patients' medical records and, in many cases, was based on information more than 4 years old, Dr. Maloney said.