Blue Shield of California on April 16 mailed notices to 12,000 physicians announcing that it would soon be publishing the results of the California Physician Performance Initiative (CPPI). The decision to publish was made despite serious concerns about the validity and accuracy of the underlying data with blatant disregard for the irreparable harm it will have on physicians’ reputations.

CPPI is a quality reporting pilot project operated by the California Cooperative Healthcare Reporting Initiative (CCHRI). CPPI uses claims data from private PPO patients from Anthem Blue Cross, Blue Shield, and United Healthcare to rate physicians on a set of quality measures.

Organized medicine in California has expressed concern regarding publishing this information as the CPPI program relies solely on claims data. The data fails to comprehensively document the care a patient receives or the reasons a patient may not receive the care that is the focus of a quality measure. For example, one physician reported that he was marked down for not recommending cervical cancer screening to patients who had undergone hysterectomies. Another physician was penalized for a procedure that he recommended, but that was subsequently denied by the HMO for medical necessity. CPPI also penalizes physicians for patients not adhering to recommended treatments.

Many organizations have voiced similar concern about the validity of the CPPI data, including county medical associations, major physician groups, the University of California at San Diego, and CCHRI’s own physician advisory group. It is important to note that CMA created a Quality Technical Advisory Committee to provide a second look at CPPI, but it too concluded that publication of the CPPI will do more harm than good because of its faulty methodologies.

Despite overwhelming evidence that the CPPI data is faulty, Blue Shield is planning to give digital “blue ribbons” to physicians who scored in the top 50th percentile. There is great concern about the implications of making this data public, given the serious concerns about its accuracy. Even a “partial” publication of the results, as is being planned by Blue Shield, is problematic given the faulty data used to score physicians. It also infers that some physicians are not quality doctors because they did not receive a “blue ribbon.”