Regence halts network opposed by Washington state doctors

Physicians and the health plan intend to collaborate on quality measures, but the defamation portion of the doctors' lawsuit against the insurer will continue.

By Amy Lynn Sorrel, AMNews staff. Dec. 25, 2006.

Physicians are celebrating an answer to their call for better quality improvement programs after Regence BlueShield announced this month that it would drop its new performance-based network in Washington state.

But that is only the first step, physicians say, toward making sure the measures that insurers use to rate physician quality are fair and do not get in the way of the physician-patient relationship.

Regence's announcement came less than a week after the American Medical Association/State Medical Societies Litigation Center joined the Washington State Medical Assn. in its lawsuit to stop the health plan from implementing its Select Network.

Doctors said the network, which graded physicians according to quality and cost efficiency, was based on inaccurate information gleaned from outdated claims data.

The WSMA sued Regence in September, claiming that the health plan defamed physicians when it told thousands of patients that their doctors did not meet the "quality and efficiency" standards to be included in the new network.

About 500 doctors were excluded from the plan set up for 8,000 patients who are members of the Society of Professional Engineering Employees in Aerospace.

"Patients' choice of a physician must not be influenced by a health insurer's mistaken assumption that low cost is the only acceptable measure of quality care," said AMA President William G. Plested III, MD.

Dr. Plested said getting involved in the lawsuit is the first test of the Association's plan that was adopted at its Interim Meeting in November to counter insurers' use of unproven efficiency criteria to compare physician performance.