Washington state doctors sue over use of performance standards

January 1, 2007

The Washington State Medical Association and five individual doctors have filed a lawsuit against Regence BlueShield for defamation and breach of contract. The WSMA claims Regence BlueShield defamed physicians when it told patients that their doctors didn't meet the "quality and efficiency" standards to be included in the insurer's new performance-based network. The WSMA also says that the health plan breached its contracts with physicians when it dropped them from the network and told patients to find new doctors.

The Washington State Medical Association and five individual doctors have filed a lawsuit against Regence BlueShield for defamation and breach of contract. The WSMA claims Regence BlueShield defamed physicians when it told patients that their doctors didn't meet the "quality and efficiency" standards to be included in the insurer's new performance-based network. The WSMA also says that the health plan breached its contracts with physicians when it dropped them from the network and told patients to find new doctors.

The physicians involved in the lawsuit claim that the insurer's decision was based on flawed data. For example, one doctor received a low quality rating for not ordering a mammogram for a patient who had had a double mastectomy. They were also not given the chance to react to the decision or use the information to improve their performance.

Regence BlueShield says "the information they used to grade doctors was gleaned from claims data, and the quality ratings were based on national professional standards for cost efficiency and adherence to evidence-based practices," reported American Medical News (10/16/2006). Still, the health plan has sent a letter to doctors and patients apologizing for any implication that the physicians not selected to participate in the performance-based network did not provide quality care. It has also delayed the implementation of the network until July 2007.