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process for reviewing rates when stake- holders or staff raise access-to-care con- cerns. The commission also says it en- forces “strict standards” in health plan contracts and, within the last year, fined a handful of managed care organizations for violations related to claims and ap- peals processing. As for a Patient Protection and Afford-

able Care Act provision that increases Medicaid payments for certain primary care services in 2013 and 2014, most states said either that they were uncer- tain it would boost participation or that it would not help to a great extent be- cause of its temporary nature and be- cause Medicaid payments would still fall below commercial rates.

GAO conducted the study to gauge Medicaid’s ability to sustain access to care when the program is growing and is expected to grow even more under fed- eral health reform. The office surveyed Medicaid officials nationwide between February and May 2012 and asked states about their programs’ experiences from 2008 through 2011.

GAO also analyzed the extent to

which Medicaid beneficiaries reported difficulties obtaining medical care. The top reasons patients cited for delaying care included:

• Cost, • Lack of transportation, • Inconvenient clinic hours, • Long wait times at appointments, • Getting an appointment too late, and • Inability to reach a provider by phone.

Blues ranking letters on the way

Beginning mid-February, physicians may begin checking their mailboxes for letters from Blue Cross and Blue Shield of Texas (BCBSTX) containing doctors’ latest ratings in the plan’s BlueCompare quality and cost-efficiency assessment program. BCBSTX says it will publish those ratings, displayed as ribbons, in its web-based “Provider Finder” tool as of June 1.

The plan also will send information

outlining a new “Physician Quality Mea- surement” (PQM) online ranking pro- gram set to launch some time later in 2013. The PQM initiative is part of a na- tional effort by the Blue Cross and Blue Shield Association (BCBSA) to improve transparency for consumers when they shop for a doctor. Under the new program, each state’s plan will rate physicians based on its choice among a pool of 20 set qual- ity measures that BCBSA indicates will come from nationally endorsed quality measures of common conditions such as asthma, back pain, diabetes, depression, and heart disease. BCBSTX says it will use the same measures for the new PQM as those used for BlueCompare (http:// .html), and the new program is meant to “enhance” the BlueCompare ratings by

displaying the details of a doctor’s mea- surement results for each quality metric. Patients searching online for a physi- cian will see a physician’s performance rating for each quality measure dis- played as a star next to his or her name, in addition to a score comparing the doctor with local peer groups. Patients also can view an online description of the quality measures used to rate each physician. “Today’s consumers are always looking for more information about physicians and quality health care,” says Allan J. Chernov, MD, BCBSTX medical director for health care quality and policy. The PQM program supports patients’ “health- care decision-making, and promotes the collaboration of physicians, patients, health plans and employers in continu- ously improving the quality of care.” Texas Medical Association Director of

Payment Advocacy Genevieve Davis says the association is working with BCBSTX to make sure the plan’s program com- plies with a 2009 state law governing physician ranking and tiering programs. TMA won legislation that gives physi- cians the right to appeal their ranking or classification before a health insurance company publishes it or to opt out of a program completely. Plans also must involve actively practicing physicians in developing quality standards used. For physicians who choose to partici- pate in a rating program, TMA wants to make sure they can truly review their quality data before Blue Cross posts it for all to see. On the other hand, messages indicating to patients that a physician has opted out should not be disparaging, Ms. Davis says. You can find information on physi-

cian rankings on the Physician Ranking page of the TMA website (http://www .aspx). The page includes “Basic Steps for Reviewing and Disputing Physician Rankings & Tierings,” a two-page guide on how to appeal your ranking. n

Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at

34 TEXAS MEDICINE January 2013

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