Texas Health Plan Drops Doctor Rating

May 11, 2009
Special Feature

In response to a probe by the Texas Attorney General�s office, Blue Cross Blue Shield of Texas says it no longer uses claims data from doctors to measure their affordability and rank them accordingly.

In response to a probe by the Texas Attorney General’s office, Blue Cross Blue Shield of Texas says it no longer uses claims data from doctors to measure their affordability and rank them accordingly. That means that an agreement with the AG’s office to stop the practice will have no effect on current business procedures, according to Darren Rodgers, president of the Blue Cross plan. The agreement also ended an investigation into allegations that Blue Cross threatened to terminate doctors who made referrals to out-of-network physicians.

While insurers assert that doctor-ranking systems help patients choose a doctor based on cost and quality, doctors claim that any system based solely on mere numbers doesn’t tell the whole story. Rankings based on claims submissions don’t take into account the nature and severity of the illness, for example, and ignore factors like patient non-compliance and clerical errors. The Texas Medical Association has lobbied the legislature to end rankings based on flawed claims data and solely on cost.

In reaching the agreement with the attorney general, Blue Cross cooperated with the authorities but denied any wrongdoing. At the same time, the health insurer said it plans to continue using claims data to measure a doctor’s compliance with certain accepted procedures.