Attorney General Cuomo, Senate Majority Leader Joseph Bruno And Assembly Speaker Sheldon Silver Agree To Pass Doctor Ranking Legislation In New York

ALBANY (November 26, 2007) - Attorney General Andrew M. Cuomo, Senate Majority Leader Joseph L. Bruno and Assembly Speaker Sheldon Silver today announced that they have agreed to pass legislation in New York based on Cuomo's Doctor Ranking Model Code.

The announcement comes after six of the top health insurance companies in New York and the nation agreed to adopt the Doctor Ranking Model Code in agreements signed with the Attorney General's Office. Four of the top insurers, including the three largest insurers in the country, have agreed to apply the principles of the Doctor Ranking Model Code nationwide. Today, the Attorney General also announced that Schenectady-based MVP Health Care, a not-for-profit company, and its Rochester affiliate, Preferred Care, with approximately 660,000 customers combined in New York, Vermont and New Hampshire, have also signed an agreement to adopt the Attorney General's Doctor Ranking Model Code.

"The legislation will codify the Doctor Ranking Model Code which protects consumers and sets a standard for all insurers to meet," said Attorney General Cuomo. "Our Doctor Ranking Model Code, based on input from the nation's leading physician and consumer advocacy groups, gives New York's consumers added protections and should encourage all insurers to adopt similar principles of accuracy, transparency, and oversight. It is imperative that New Yorkers aren't steered to certain 'preferred' physicians based solely on cost, but instead have access to clear and meaningful measurements of quality of care to help them make well-informed decisions."

The comprehensive legislation will be the first in the nation and will track Cuomo's Doctor Ranking Model Code created in consultation with the American Medical Association, the Medical Society of the State of New York, and the Consumer Purchaser Disclosure Project (an umbrella organization which includes the AARP, Consumers Union, and the National Partnership for Women & Families). The North Shore Physician Organization also provided key assistance to the Attorney General's doctor rankings initiative.

Senate Majority Leader Joseph L. Bruno said, "Consumers need all the information they can get to select doctors and make critical health care decisions. Attorney General Cuomo's model ranking program will enable patients to make informed decisions about their physicians to ensure a high quality of care. The Senate will work with the Attorney General to enact his program into law."

Assembly Speaker Sheldon Silver said, "In order to make smart decisions about their health care, it is absolutely essential for consumers to have adequate and accurate information. If health insurance providers do rankings of physicians, consumers must be confident that those rankings rate quality of care first. The legislation being proposed today takes the necessary steps to ensure that New Yorkers making critical medical decisions are doing so armed with reliable and useful data."

Cuomo's Doctor Ranking Model Code reforms doctor ranking programs by compelling insurers to fully disclose to consumers and physicians all aspects of their ranking system. Additionally, under this model, the insurer must retain an oversight monitor, known as a Ratings Examiner ("Rx"), who will oversee compliance with all aspects of the agreement.

Under the Doctor Ranking Model Code and the legislation, insurers will:

  • Ensure that rankings for doctors are not based solely on cost and clearly identify the degree to which any ranking is based on cost;

  • Use established national standards to measure quality and cost efficiency, including measures endorsed by the National Quality Forum (NQF) and other generally accepted national standards;

  • Employ several measures to foster more accurate physician comparisons, including risk adjustment and valid sampling;

  • Disclose to consumers how the program is designed and how doctors are ranked, and provide a process for consumers to register complaints about the system;

  • Disclose to physicians how rankings are designed, and provide a process to appeal incorrect rankings;

  • Nominate and pay for the Rx who will oversee compliance with all aspects of the new ranking model.

David W. Oliker, President and Chief Executive Officer of MVP Health Care, said, "MVP Health Care physician reporting does not currently include physician rankings, but we have entered into this agreement with Attorney General Cuomo because we share his belief that consumers are entitled to receive accurate and reliable information upon which to make important health care decisions."

Paul Macielak, President and Chief Executive Officer of the New York Health Plan Association, said, "We look forward to working with the Attorney General and the Legislature to codify a Model Code embodying the principles set forth by the Attorney General. This will empower consumers with reliable information on how well physicians are delivering care based on nationally accepted treatment standards."

The Medical Society of the State of New York President Dr. Robert Goldberg said, "Attorney General Andrew Cuomo has made impressive strides in making doctor ranking programs of insurers accurate, reliable and accountable - by persuading New York State's major insurers to adopt his principles of accuracy, transparency and oversight as he formulates his national Physician Ranking Model Code. The Medical Society of the State of New York worked with the Attorney General to develop this model, and now we welcome the opportunity to help him take another step forward by supporting the concept of his plan to codify his doctor ranking model with meaningful legislation."

The American Medical Association's President-elect Nancy Nielsen M.D. said, "Attorney General Cuomo is to be credited for persuading many of the nation's largest health insurers to acknowledge the risks of physician profiling. His work to minimize these risks has resulted in agreements that provide crucial protections for patients and physicians, and we commend state government leaders for their commitment to codifying the safeguards necessary to ensure the integrity of physician profiling initiatives."

Consumers Union Programs Director Chuck Bell said, "I want to again thank Attorney General Cuomo for standing up on behalf of consumers across the country, the AMA and MSSNY for working with us on creating this model and MVP/Preferred Care for being a leader in the industry and adopting this model for their reporting programs in New York. We also commend Assembly Speaker Silver, Majority Leader Joseph Bruno and Senator Hannon for their leadership and support for the proposed legislation, which we expect will have the enthusiastic support of consumer organizations and purchasers throughout New York State."

"The New York State Conference of Blue Cross and Blue Shield Plans (NYSCOP) applauds Attorney General Cuomo's leadership in developing a Model Code for certain measurements which rank physician performance," said NYSCOP Vice President Deborah Fasser. "These measurements can be valuable tools for our customers in selecting physicians. We also recognize the need for this information to be uniform, comprehensive, and reliable. We look forward to working with the Attorney General and the Legislature to codify these principles into legislation."

Doctor ranking programs are a rapidly growing practice within the health care industry. Major insurers nationwide either operate or are in the process of developing these programs.

During the past few weeks, several of the nation's largest health insurance companies have agreed to adopt Cuomo's Doctor Ranking Model Code and use it nationwide:

  • Cigna Healthcare adopted the Doctor Ranking Model Code in New York through an agreement with the Attorney General and will voluntarily apply the principles of the Doctor Ranking Model Code nationwide (October 29, 2007);

  • Aetna adopted the Doctor Ranking Model Code in New York through an agreement with the Attorney General and will voluntarily apply the principles of the Model Code nationwide (November 13, 2007);

  • Empire Blue Cross Blue Shield, the largest health insurer in New York, adopted the Doctor Ranking Model Code in New York through an agreement with the Attorney General. Empire's parent, Wellpoint, the nation's largest health insurer, will voluntarily apply the principles of the Doctor Ranking Model Code nationwide (November 14, 2007);

  • UnitedHealthcare and Oxford Health Plans adopted the Doctor Ranking Model Code in New York through an agreement with the Attorney General. UnitedHealthcare will voluntarily apply the principles of the Doctor Ranking Model Code nationwide (November 20, 2007);

  • Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), which are subsidiaries of EmblemHealth, Inc., adopted the Doctor Ranking Model Code through an agreement with the Attorney General (November 20, 2007);

  • MVP Health Care and its affiliate Preferred Health adopted the Doctor Ranking Model Code in New York through an agreement with the Attorney General (November 26, 2007).

The Attorney General's industry-wide investigation of doctor ranking programs is ongoing and is being handled by Linda Lacewell, the head of the Attorney General's Healthcare Industry Taskforce.

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