MMS files suit over doctor ranking system

June 14, 2008

The Massachusetts Medical Society announced that it has filed legal action seeking to “correct the wrongs” of the physician ranking program implemented by the Massachusetts Group Insurance Commission, the purchaser of health insurance for most state employees and retirees.

The complaint, filed in Suffolk Superior Court, alleges that patients have been defrauded and harmed and physicians have been defamed by the GIC’s Clinical Performance Improvement initiative, a program that ranks individual physicians in one of three tiers, using various cost and quality measures.

Patients are charged higher co-payments if they are treated by physicians assigned to the lower two tiers.

The filing asks the court to either stop the tiering program or require that the initiative adhere to specific standards – including transparency, fair notice, and formal feedback and correction processes – and allow meaningful physician involvement in the development of the standards.

The suit also asks for the GIC to demonstrate the program’s accuracy, validity and reliability, and submit the program to an independent oversight authority. MMS has asked GIC to voluntarily submit to these requests on several occasions.