During the past few weeks, three major health insurance companies in New York state -- CIGNA, Aetna and Empire BlueCross BlueShield -- have bent to pressure applied by New York Attorney General Andrew Cuomo and agreed to restructure their physician ranking programs.
NY Attorney General Reins In Physician Ranking Programs
Three Major Payers Agree to Overhaul
By Sheri Porter
11/16/2007
Cuomo launched an investigation into the payer programs last summer and, on Oct. 18, issued a consumer alert about what he called "potentially deceptive programs." In that press release, Cuomo told consumers "to be aware that doctor ranking programs as currently designed may steer patients to the cheapest, but not necessarily the best doctors, letting profits trump quality."
Physician ranking programs have long been a source of friction between the AAFP and some of the country's largest payers, said AAFP Board Chair Rick Kellerman, M.D., of Wichita, Kan. He noted that the issue had appeared on nearly every meeting agenda between the AAFP and insurance company executives.
Kellerman applauded CIGNA for leading the way among health plans by signing an agreement that would, according to an Oct. 29 press release from Cuomo's office, serve as a "new national model for doctor ranking programs."
It didn't take long for two other major players in the New York health insurance market to follow CIGNA's lead. On Nov. 13, Cuomo announced that Aetna had signed a similar agreement; the next day, his office issued a press release stating that Empire BlueCross BlueShield had agreed to adopt the attorney general's model for physician ranking programs.
"Transparency works both ways," said Kellerman. "Physicians are being asked to provide transparency in their practices, and the Academy believes that insurance companies should follow similar rules of transparency in their business dealings with physicians."
When physicians are engaged in ranking programs, "we need to know what the criteria are, and we need to know how payers are using our information to rank us as individual physicians," said Kellerman.
Dick Salmon, M.D., CIGNA's national medical executive for health programs medical management, said his company was very pleased with the new program model. "We think the agreement that we reached with the New York attorney general is completely in line with the principles that have guided our work in this area."
Salmon, a family physician and AAFP member, called the move "good for doctors." National standards will enable the industry to move more quickly toward a uniform approach to physician ranking that all payers can follow and that will benefit consumers as well, he said.
Under the terms of their agreements, all three companies will, among other things:
Physician ranking programs have long been a source of friction between the AAFP and some of the country's largest payers, said AAFP Board Chair Rick Kellerman, M.D., of Wichita, Kan. He noted that the issue had appeared on nearly every meeting agenda between the AAFP and insurance company executives.
Kellerman applauded CIGNA for leading the way among health plans by signing an agreement that would, according to an Oct. 29 press release from Cuomo's office, serve as a "new national model for doctor ranking programs."
It didn't take long for two other major players in the New York health insurance market to follow CIGNA's lead. On Nov. 13, Cuomo announced that Aetna had signed a similar agreement; the next day, his office issued a press release stating that Empire BlueCross BlueShield had agreed to adopt the attorney general's model for physician ranking programs.
"Transparency works both ways," said Kellerman. "Physicians are being asked to provide transparency in their practices, and the Academy believes that insurance companies should follow similar rules of transparency in their business dealings with physicians."
When physicians are engaged in ranking programs, "we need to know what the criteria are, and we need to know how payers are using our information to rank us as individual physicians," said Kellerman.
Dick Salmon, M.D., CIGNA's national medical executive for health programs medical management, said his company was very pleased with the new program model. "We think the agreement that we reached with the New York attorney general is completely in line with the principles that have guided our work in this area."
Salmon, a family physician and AAFP member, called the move "good for doctors." National standards will enable the industry to move more quickly toward a uniform approach to physician ranking that all payers can follow and that will benefit consumers as well, he said.
Under the terms of their agreements, all three companies will, among other things:
- ensure that physician rankings are not solely cost-based;
- use established national standards, including those endorsed by the National Quality Forum, to measure quality;
- incorporate measures to foster more accurate physician comparisons;
- disclose to physicians how rankings are designed and provide a process to appeal incorrect ratings;
- disclose to consumers how physicians are ranked and provide a process for consumers to register complaints about the system; and
- nominate and pay for a ratings examiner -- subject to the attorney general's approval -- to oversee the ranking program's compliance activities.
In addition, CIGNA and Aetna have both pledged to apply the model nationwide.
"These principles have to do with reliance on national standards using the most robust data set available," said Salmon. He added that by signing the agreement, CIGNA was honoring its members' "right to know the best information available about physicians," but with the added responsibility of "fully disclosing the limitation of that information and using that information responsibly."
Vito Grasso, EVP of the New York AFP, confirmed that FPs in the state had been affected by physician ranking programs and called the agreements "a positive development."
He applauded Cuomo for initiating the original investigation and for exposing a "defective system." The attorney general's actions "established the precedent that, in fact, government does have an interest and a role in assuring that this type of information is disclosed," said Grasso.
"These principles have to do with reliance on national standards using the most robust data set available," said Salmon. He added that by signing the agreement, CIGNA was honoring its members' "right to know the best information available about physicians," but with the added responsibility of "fully disclosing the limitation of that information and using that information responsibly."
Vito Grasso, EVP of the New York AFP, confirmed that FPs in the state had been affected by physician ranking programs and called the agreements "a positive development."
He applauded Cuomo for initiating the original investigation and for exposing a "defective system." The attorney general's actions "established the precedent that, in fact, government does have an interest and a role in assuring that this type of information is disclosed," said Grasso.
