With the help of a computer algorithm, Massachusetts’ biggest health insurer says it will scrutinize doctors who frequently bill it for the most expensive patient visits. It will then unilaterally cut payments to physicians it concludes charged too much.
Targeting what it described as a small percentage of “outliers,” Blue Cross Blue Shield of Massachusetts plans to roll out the new program around Nov. 3. The insurer says health care costs are increasing at their fastest rate in more than 20 years and that it has a duty to help control them for its 3 million members.
But the move has angered some doctors, particularly those who often see older, medically complicated patients in need of more care and time. They say Blue Cross’s initiative fails to recognize a simple fact of medicine: Patients and treatments don’t fit neatly into categories used by insurers and software developers.
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