Fight over physician quality ratings moves to Massachusetts

The dispute focuses on tiered networks covering public employees and a state insurance commission's request for rankings data.

By Emily Berry, AMNews staff. Dec. 24/31, 2007.

Despite deals in New York that insurers pledge will improve their tiered networks nationwide, physicians are not assured that networks based on quality ratings will be to their liking.

One of the hottest battles over tiered networks is going on in Massachusetts. It involves the tiered network system mandated by the Massachusetts state employees health insurance program, the Group Insurance Commission. In November, the GIC started accepting proposals from health plans that would set up networks covering not only 250,000 state employees, but also potentially another 330,000 municipal employees as the program expands to cover any state and local public employee.

The commission and its insurers actually released their first networks based on quality ratings in April, but the expansion of its networks, and physicians' dislike of how ratings are established, has the Massachusetts Medical Society speaking out against the commission's tiered networks. In this fight, allies include legislators pushing House and Senate bills governing standards for tiered networks, and, in a case of strange bedfellows, BlueCross BlueShield of Massachusetts, which said it would refuse to submit a proposal.

Katherine Atkinson, MD, a family physician in Amherst, Mass., said GIC health plans have sent notices to physicians informing them that they are in low tiers without offering an explanation, and without any chance to appeal their ranking.

Worse, she said, the rankings are based largely on cost, but patients don't know that -- they assume the doctor must be incompetent or have committed malpractice.