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Physician Quality Ruling Favors Blue Shield of California

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A state court judge in Alameda County, Calif., has dismissed efforts by physicians and a state medical society to kill a Blue Shield of California physician quality recognition program.

Blue Shield of California, San Francisco, set up a “Blue Ribbon” program to identify high-volume physicians in its provider directory who have received high quality ratings from a program organized by the Pacific Business Group on Health (PBGH), San Francisco.

The PBGH rating program focuses mainly on efforts to improve preventive care andScales of justice manage chronic conditions.

The California Medical Association (CMA), Sacramento, Calif., and two CMA member physicians sued, arguing that the Blue Ribbon Program is based on selective data and is given to physicians who cost Blue Shield of California less per visit than other physicians cost.

Judge Steven Brick has dismissed the suit outright, arguing that the Blue Ribbon program is a form of “protected consumer information.”

To proceed with a suit involving protected information, Blue Shield of Califronia had a burden to “establish a probability of prevailing on merits,” Brick says in his ruling.

The plaintiffs “have failed to address or rebut defendants’ argument that the First Amendment [of the U.S. Constitution] bars all of plaintiffs’ claims…” Brick says. “For this reason alone,

plaintiffs have failed to meet their burden.”

The plaintiffs also have failed to provide admissible evidence showing that they suffered a loss of business or suffered other harm because of the Blue Ribbon program, and the CMA has not shown how the program has impeded its own activities, Brick says.

There also has been no evidence that “a Blue Shield member or member of the public has relied upon the Blue Ribbons for any purpose, let alone that such reliance caused plaintiffs to incur harm,” Brick says.

Dr. Michael-Anne Browne, the Blue Shield of California medical director, says in a statement that the ruling validates the idea that Blue Shield of California has a right to recognize high performing physicians through its Blue Ribbon program.

“The Blue Ribbon program recognizes thousands of high-volume, higher-performing doctors and has broad support from businesses, consumer advocates, labor organizations and others for breaking new ground in health care transparency,” Browne says. “We are fully committed to providing our members and the general public with information they can use in evaluating the physicians who best fit their needs.”

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