An Amazing Post on GIC Tiering By a Primary Care Physician

Dr. Sally Ginsburg, pediatrician from Longmeadow, has written an amazing post on the absurdities of the Group Insurance Commission's physician tiering program. It's on WBUR's "CommonHealth" blog. We heartily recommend a close, careful reading of her points.

She agrees that health care must be delivered more efficiently and that quality must be improved. But she cites many examples of where tiering clearly fails the test.

She concludes, "Look at where the BIG health care money is really being spent- high cost, end of
life care and very costly and sometimes futile beginning of life care. Stop
playing this out on the primary care physicians, before there are none of us
left in the state."

The Massachusetts Medical Society has filed suit against the GIC to "correct the wrongs" of the tiering system. We contend that the GIC's tiering system is not only complex, it is impossible to understand. It is
not only unfair, it is inaccurate. It is supposed to save money and
reduce costs, but there is no evidence it does either – and there is a
lot to suggest it actually does the opposite. It is unfair to physicians, and it misleads patients.

In December, a state judge held a hearing on the GIC's contention that the complaints of the MMS and five physician co-plaintiffs were without merit. A ruling on the matter is still pending.

Meanwhile, the GIC's health plans have released the tier designations for program's fourth year, and the inequities and inaccuracies seem as bad as ever, if not worse.

This isn't the way to address cost and quality. It's time to move on to something else.

Bruce Auerbach, MD
President, Massachusetts Medical Society

  1. Sally Ginsburg MD says:

    I greatly appreciate, and am flattered by, the praise of my article by Dr. Auerbach. I have been working on researching and analyzing the data that has been provided to me (such that it is) by one of the insurers. The inaccuracies are glaring… 28-37 year olds being attributed to me? Please, I have not seen any such patients since medical school! I have been “credited” with doing pharyngeal abscess drainage, deliveries, and overnight EEGs. I am impressed by the variety of technical skills the GIC thinks I have! A BIG problem with the data is that the costs attributed to me are higher than any bill EVER sent out from our practice billing office. Despite the methodology utilized (25% or more of the cost gives the whole ETG to me), there are many glaring cases where these numbers do NOT add up. It is incredulous that the GIC and the insurers continue to claim that this data is clean and accurate.
    Perhaps this wheel is broken and needs to be fixed?! Hopefully the MMS court case will settle that!

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