The lawsuit (PDF format) alleges that patients and physicians were harmed and deceived by the GIC’s Clinical Performance Improvement (CPI) initiative, which ranks (or “tiers”) individual physicians using various cost and quality measures.
The suit, which names GIC, its executive director, Tufts Health Plan and the UniCare Life and Insurance as defendants, asks the court to either halt the CPI’s tiering program or require the CPI to “adhere to specific standards, including transparency, fair notice, formal feedback and correction processes, meaningful physician involvement in the development of the CPI, demonstrate the program’s accuracy, validity and reliability, and submit their programs to an independent oversight authority,” according to the MMS.
The GIC purchases health insurance for most Massachusetts state employees and retirees.
“Physicians are very sensitive to the fact that healthcare costs must be controlled. We are also committed to continually working and seeking innovative initiatives to improve the quality of the care we provide. Good information can be instrumental in reaching these goals, so we have always supported meaningful efforts that seek to improve efficiency and quality. They must, however, be associated with the collection and reporting of valid, useful information to patients and physicians,” said Bruce S. Auerbach, MD, president of the MMS, according to the MMS.
Read the statement from the Massachusetts Medical Society.
