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New Analysis Underscores Legality of Physician Ranking and Public Reporting Systems When Used by Health Insurers to Improve Health Care Quality
Date:10/9/2007

Key Success Factors Include Openness of Process and Standards Development,

Clear Method to Identify and Correct Errors

WASHINGTON, Oct. 9 /PRNewswire-USNewswire/ -- A legal analysis released today by The George Washington University School of Public Health and Health Services (GW) and the Robert Wood Johnson Foundation (RWJF) affirms the legality under federal and state law of physician ranking systems used by health plan provider networks. Recent efforts by health plans to measure and disclose physician performance on quality and efficiency have created a backlash, with some questioning whether such practices are legal.

Funded by RWJF and conducted by a team of GW researchers, the analysis examines the principal legal allegations that might be raised against the practice of tiering physicians in networks based on quality and efficiency measures. The analysis concludes that well-designed tiering arrangements pass legal muster.

"The GW analysis demonstrates that, done properly, physician rankings should not raise legal concerns, either for those who are pushing the standards, or those being measured," said Michael W. Painter, MD, JD, senior program officer for the Robert Wood Johnson Foundation. "Physician rankings are a critical component of the broader movement to measure and publicly report on physician and hospital performance to help improve the quality and value of health care Americans receive."

The analysis comes at a time when an increasing number of health care plans are creating tiers that rank physicians' performance by the quality and effectiveness of their care. State-level criticisms of physician-tiering arrangements have recently emerged. In August 2007, New York Attorney General Andrew Cuomo wrote letters to various insurers objecting to a physician ranking program and requesting that the tiering system be justified. Also in August, Regence BlueShield and the Washington State Medical Association (WSMA) settled
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SOURCE Robert Wood Johnson Foundation; George WashingtonUniversity School
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