American Medical News writes: On March 30, a trial court green-lighted a lawsuit brought by the Massachusetts Medical Society and five doctors to halt a physician tiering program mandated in 2006 by the Group Insurance Commission, a state agency that oversees health insurance for public employees. Doctors also are suing two health plans participating in the program, called the Clinical Performance Improvement Initiative. It purports to improve quality and restrain costs by grading doctors’ performance based on those factors.
But physicians contend that the methodology used to rate them is faulty and has led to serious errors that have forced patients to pay more for their care and unfairly damaged physicians’ credibility. A Suffolk Superior Court judge allowed the doctors to sue over claims that the tiering program defames them and defrauds patients. The court dismissed other parts of the suit.
AMA policy states that rating systems should be transparent and based on evidence-based quality measures, rather than cost. The AMA also urges health plans to allow physicians to review the data behind such ratings and have the ability to appeal them.