Providers say they are frustrated and angry enough to file lawsuits against insurers that have initiated programs to measure the quality of physicians in order that employers can curb healthcare costs, reports the Associated Press. The article quotes physicians who are suing Regence BlueShield over a program, now defunct, that barred them from a network of high-quality physicians. The physicians say insurers are choosing low-cost physicians to be in high-quality networks and are basing their measures of quality on claims data instead rather than on medical records, which provide a truer picture of quality. Insurers such as Cigna Corp., UnitedHealth Group Inc., Aetna Inc., and WellPoint Inc. argue that ratings are based on “very good” measures and that having patients seek care from high-quality providers can lower healthcare costs by 3% to 5%. But only about 9% of large employers are adjusting benefit levels to provider quality ratings, according to Mercer Health & Benefits LLC, due to concerns that there are no universally accepted quality measures. And physicians often have no idea how much procedures cost, said one Aetna medical director, even if they do understand that employers want assurances that they’re receiving high quality for their healthcare dollars.
