CMA Urges Physicians to Correct Data Used by Payors to Grade their Performance
[Posted 10/13/08]

In the last three weeks, some 20,000 California physicians received letters from the California Physician Performance Initiative (CPPI). These letters contain raw and relative performance scores for physicians on 15 quality measures based on claims data from Medicare and United Health, Blue Cross, and Blue Shield PPOs. The
letters do not contain the underlying data.

CMA has serious concerns about the accuracy and integrity of the data used to establish these scores and the potential use of these scores or these metrics by payors to do pay-for-performance or create tiered networks. In order to address CMA concerns and to improve the quality of the data, CPPI has created a reconsideration process that physicians should use to verify the data.

CMA urges all physicians to request their data from CPPI and verify its accuracy.

In checking the data, physicians should check whether CPPI correctly listed the patient name, physician name, and specialty, and whether or not the physician performed the procedure. If you did not perform the procedure, we encourage you to explain why, and, if applicable, why the particular metric does not make sense as a measurement of the quality of care you provided to your patient.

We understand that this may be a time-consuming process, but it is critical for physicians to take the time to verify their data. If you do not raise concerns now, payors will use this data in the future to adjust your reimbursements and change the flow of patients to your practice.

CMA also asks that you share any corrections or concerns about the data with us. (Please do not send any patient information covered by HIPAA.)

Step by step instructions on obtaining and reviewing your patient data is available here.

Once you have completed the reconsideration process, please also take CMA’s online survey to tell us what, if anything, was wrong about your performance scores. This step is important to ensure that CMA has the information needed to advocate on your behalf.

Contact: CMA Member Help Line, 800/786-4CMA (4262).