Regence tells 8,000 people they must find new doctor

Nearly 500 doctors have been dropped from a health plan run by Regence BlueShield, one of the state's largest health insurers, which has sent letters to some 8,000 patients contending that the doctors' "quality and efficiency" didn't measure up.

Now the Washington State Medical Association is demanding an apology, saying the decision to drop the doctors had nothing to do with quality of care but was a cost-cutting measure based on a controversial ratings system.

"I'm not a lawyer, but that's a pretty egregious thing to say about somebody in print," charged Dr. Peter Dunbar, the association's president. "This is a very heavy-handed, crude message. The communication is just absolutely reprehensible."

Regence sent the letter last week to the patients of about 480 doctors who participate in the Regence Select Network. The letter instructed them to find new, approved physicians by July 1 if they want Regence to cover care. Unlike some plans, the Select Network doesn't allow patients to pay extra to see "out-of-network" doctors, except in emergencies.

Regence wasn't immediately able to say how many doctors or patients are in the Select Network. It is one of two plans that Boeing offers to 45,000 engineers and family members.

This is just the latest dust-up over Regence's controversial rating system, which attempts to measure doctor performance to identify those who spend too much compared to their peers or don't deliver widely accepted treatments. The most "efficient" doctors are selected for the Select Network, which costs employers less and offers wider coverage to employees.

But how Regence rates the doctors is a mystery, Dunbar said. "Regence has a black box," he said. "The individual physician has no idea what's being measured."

Regence instituted the ranking system in the early 1990s but abandoned it after doctors complained that ratings were skewed against doctors of the sickest patients because they spent the most. But it was reinstituted a few years ago.

Mary McWilliams, Regence president, said the system was developed because large employers wanted physician networks based on "performance measurement."

"This is not a cloak for cost control but an effort to promote quality as well as efficiency in the care of patients," McWilliams said.

Doctors dropped from the Select Network could still qualify to participate in other Regence health plans, Regence said in a statement, which did not elaborate.

In addition to ranking doctors' costs of treatment, Dr. Joe Gifford, chief medical officer for Regence, said the rating system looks at doctors' "quality measures," such as prescribing the appropriate medications for congestive heart failure or asthma.

"A tremendous amount of effort has gone into doing this the right way," Gifford said.

But Dunbar said he was outraged that the insurer would tell patients their doctor's "quality" was low.

Dunbar, an anesthesiologist at Harborview Medical Center, said Regence's rating system is taken entirely from billing data, not from patient outcomes or other such measures of quality care. "I think there's little doubt [the ratings] are about cost," he said.

The doctors association, in addition to an apology, also is demanding that Regence suspend its grading system until it can produce "meaningful information that leads to better care," as well as an appeal process for doctors.

Dr. Gary German, a Renton pediatrician, said he and three colleagues in his practice were dropped despite their extremely low patient hospitalization rates, as well as the doctors' stellar backgrounds and enthusiastic patients.

"It was very much a shock for all of us because we consider ourselves, as do our patients, well respected and good pediatricians," said German, who has been chief of pediatrics and medical director at Valley Medical Center in Renton and has served on the executive committee at Children's Hospital & Regional Medical Center.

He said he doesn't quarrel with such ratings systems, if done correctly. "But it's too complicated to put into a few numbers without taking the human part of it."

For example, Regence's measurements don't measure patient satisfaction or the end results, including rates of hospitalization, German said.

"This is their attempt at micromanaging the way physicians are supposed to see patients," German said. "Medicine is both an art and a science, not something you can micromanage with numbers."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com