Blue Cross and Blue Shield of Texas has agreed to stop using its risk-adjusted cost index to rate physicians as more or less affordable in providing medical treatments to patients, following an order from Texas Attorney General Gregory Abbott. The insurer has also agreed not to terminateor threaten to terminatephysicians for making referrals outside of the Blue Cross and Blue Shield network.
According to the order, the Consumer Protection & Public Health Division of the attorney generals office began an investigation in January 2008 into Blue Cross and Blue Shield of Texas use of its risk-adjusted cost index methodology to conduct and publish affordability quality assessments of healthcare providers, as well as the companys communications that threatened to terminate those physicians who referred patients for treatment outside the network.
Josie Williams, a physician who serves as president of the Texas Medical Association, called the order a huge victory for patients because, she said, patients and their doctors should make decisions regarding patient care. She said Blue Cross and Blue Shield of Texas is not the only insurer that has ranked hospitals using claims data.
After listening to the concerns expressed by the attorney generals office and other constituents, Blue Cross and Blue Shield of Texas voluntarily modified certain business practices related to (the) provision of consumer information several months ago, Margaret Jarvis, a company spokeswoman, said in a written statement. The statement also said the company recognizes that employers and consumers who purchase network-based products count on health plans to limit their exposure to unregulated costs from out-of-network providers. As a result, Blue Cross and Blue Shield of Texas said it changed its language to more clearly state that physicians have the right to discuss all available treatment options.