Massachusetts Medical Society applauds Superior Court decision on GIC's Physician Tiering Program
Court allows lawsuit to proceed on defamation, consumer protection

Waltham, Mass. - April 2 -- The Massachusetts Medical Society today applauded the decision of the Suffolk Superior Court in legal action filed by the Massachusetts Medical Society and five physicians against the Massachusetts Group Insurance Commission (GIC) and two health plans, allowing a lawsuit to proceed on two critical issues of physician defamation and consumer protection.

The cas e centers on the GIC's Clinical Performance Improvement initiative, a physician ranking program implemented by the GIC in 2006 that places individual physicians in one of three tiers using various cost and quality measures. Patients are charged higher co-payment fees to be treated by physicians assigned to the lower tiers, or must try to change physicians to avoid higher co-payments.

The Medical Society has said that the program lacks a valid and accurate methodology to properly evaluate physicians and therefore harms physicians and misleads patients.

The Court's decision responded to requests by the GIC and the health plans named in the suit to dismiss the lawsuit filed by the Medical Society and five physicians last year.

Noting that the Medical Society has legal standing to sue on behalf of its members, the Court, while dismissing several counts in the complaint as a matter of law, allowed the two most important claims of defamation and consumer protection, which means the lawsuit can move ahead.

"This is a huge step forward for physicians and patients," said Bruce Auerbach, M.D., President of the Massachusetts Medical Society. "Physicians have been unfairly evaluated, and patients have been misled by a seriously flawed system designed simply to control costs. The tiering program forces patients to pay more for their care and damages the physician-patient relationship and the hard-earned reputations of physicians. We are thrilled that the Court has allowed the case to move ahead."

Last May, the Medical Society and five physicians sued the GIC and Tufts Health Plans and Unicare, alleging that patients have been defrauded and harmed and physicians have been defamed by the GIC's initiative. The filing asked the court to either stop the tiering program, or to require that the CPI 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.

Dr. Auerbach said the Medical Society took legal action as a last resort. He said the Society had tried to work with the GIC for four years in fixing the flaws in the program, but said the GIC refused to correct the CPI's most glaring problem, which is its ranking of individual physicians using inaccurate, unreliable and invalid tools and data.

Dr. Auerbach said that the methodology of the CPI is so bad that physicians have been attributed patients they did not see and assigned procedures they did not conduct. In addition, physicians have received reports that are unintelligible, and they have been given little time to appeal any evaluations.

"Even today," said Dr. Auerbach, "with the program entering its fourth fifth year, we are hearing complaints from physicians that the program is as bad as ever."

The Court's decision may be found here. <http://www.massmed.org/AM/TemplateRedirect.cfm?Template=/CM/ContentDisplay.cfm&amp;ContentID=29199>

The Massachusetts Medical Society, with more than 21,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes the New England Journal of Medicine, a leading global medical journal and web site, and Journal Watch alerts and newsletters covering 13 specialties. The Society is also a leader in continuing medical education for health care professionals throughout Massachusetts, conducting a variety of medical education programs for physicians and health care professionals. Founded in 1781, MMS is the oldest continuously operating medical society in the country. For more information please visit www.massmed.org <http://www.massmed.org/> , www.nejm.org <http://www.nejm.org/> , or www.jwatch.org <http://www.jwatch.org/> .