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Post date: December 12 2007

Attorney General Cuomo Announces

BUFFALO, NY (December 12, 2007) – Attorney General Andrew M. Cuomo today announced an agreement with Buffalo-based Independent Health Association, Inc., in which the company has adopted Cuomo’s Model Code for doctor ranking programs.

With this agreement signed today, a total of seven state, regional and national insurers have adopted Attorney General Cuomo’s Doctor Ranking Model Code.

“I applaud Independent Health for embracing the Model Code,” said Cuomo. “My Model Code, which was based on input from the nation’s leading physician and consumer advocacy groups, gives New Yorkers added confidence when choosing a physician. All insurers should adopt these principles of accuracy, transparency, and oversight as Independent Health has done. The Model Code helps protect consumers from being directed to certain ‘preferred’ physicians based solely on cost, and gives them access to clear and meaningful measurements of quality of care to help them make well-informed decisions.”

Independent Health has more than 360,000 customers, most of whom are located in western New York.

Michael W. Cropp, M.D., President and Chief Executive Officer of Independent Health, said, “As a nationally recognized health plan, Independent Health has always focused on the needs of our members. Although we do not have a physician tiering program currently, we have signed the agreement because we share the Attorney General’s goal of maintaining accuracy, accountability and transparency in the information we provide to our members and physicians. Independent Health is a physician-led organization with longstanding partnerships with physicians in our community. We look forward to working with the Attorney General’s office and our physician partners so we can provide our members with necessary information about the quality of care they receive.”

New York’s legislative leaders recently announced plans to pass legislation codifying Cuomo’s Doctor Ranking Model Code.

Cuomo’s Model Code was created in consultation with the American Medical Association and the Medical Society of the State of New York, along with a host of consumer advocacy groups including 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.

American Medical Association President-elect Nancy Nielsen, M.D., said, "The AMA commends Independent Health for voluntarily joining the ongoing shift in the health insurance industry's stance on physician profiling. Although Independent Health does not profile physicians, its agreement with the Attorney General indicates that a primary commitment to quality improvement already exists within the company."
Chuck Bell, Programs Director for Consumers Union, the nonprofit publisher of Consumer Reports magazine, said, “Consumers Union strongly supports the core principles of the agreement that Attorney General Cuomo has concluded with Independent Health – disclosure, use of nationally-recognized quality measures, and independent oversight. These principles will help ensure that information about physician performance is collected and reported in a fair way. We congratulate Independent Health for embracing this model, which will help ensure that consumers receive accurate and reliable information.”
Lois Aronstein, AARP New York State Director, said, “For too long, consumers have had to rely on word of mouth recommendations without being able to see specific, objective information about how well their doctors perform. AARP strongly supports efforts to give consumers this type of information as well as publicly disclosing the methods used to determine rankings and making those rankings fully transparent.”

The 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 and report to the Attorney General every six months.
Under the national model, 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 disputed ratings;

Nominate and pay for the Ratings Examiner, subject to the approval of the Attorney General, who will oversee compliance with all aspects of the new ranking model and report to the Attorney General’s office every six months; the Ratings Examiner must be a “national standard setting organization” and will be national in scope, independent, and an Internal Revenue Code § 501(c)(3) organization.

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

Other companies to adopt the Model Code are: CIGNA Healthcare, Aetna, Empire Blue Cross Blue Shield, UnitedHealthcare, GHI/HIP and MVP Health Care/Preferred Care. CIGNA, Aetna, UnitedHealthcare and Empire’s parent, WellPoint, will also apply the principles of the Attorney General’s Doctor Ranking Model Code nationwide.

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.