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Post date: November 13 2007

Attorney General Cuomo Announces Doctor Ranking Agreement With Third Largest Health Insurer In U.s.

NEW YORK, NY (November 13, 2007) - Attorney General Andrew M. Cuomo today announced an agreement for doctor ranking programs with Aetna (NYSE: AET), the third largest health insurer in the country with over 16 million members nationwide. Aetna is the second insurer to adopt the Attorney General's model and is the first to apply it nationwide.

"Choosing a doctor is obviously a very important decision and the information health care companies provide to consumers must be fair and complete. Health insurance companies are beginning to realize if they want to implement a doctor ranking program, they should adopt our national model, which is supported not just by insurers, but also by national physician and consumer groups," said Cuomo. "I commend Aetna for being among the first to step forward and I encourage other insurance companies who are considering doctor ranking programs to follow Aetna's example."

"Aetna is proud to be among the first insurance companies to adopt the Attorney General's national model and to be the first to work with consumer groups to apply the principles of the agreement nationally to our program," said Troyen A. Brennan, M.D., Aetna's chief medical officer. "We are committed to providing our members with a physician performance evaluation program that is easy to understand and takes into account the input of participating physicians. Thanks to the Attorney General, we now have the ability to strengthen our program to make it consistent with a model across insurance carriers to the benefit of all consumers that is accurate, transparent and fair for all parties. Aetna is committed to transparency of information to physicians, members and employers who purchase health plans."

"The American Medical Association commends Aetna for being the first health insurer to commit to these important safeguards nationwide," said the American Medical Association's President-Elect, Dr. Nancy Nielsen. "Patients and physicians throughout the country deserve to be protected from inaccurate ratings, which undermine the physician-patient relationship. We are very pleased that Attorney General Cuomo's timely and effective advocacy is already having a national impact."

Aetna's existing program, known as "Aetna Aexcel," designates physicians in 12 specialty categories who have passed certain clinical quality and cost efficiency measures. Before today's agreement, Aetna did not identify to its consumers how much of the evaluation process was based on cost efficiency and how much on quality measures, which Aetna will now do.

On Monday, October 29, 2007, Attorney General Cuomo announced the first doctor ranking agreement with CIGNA, establishing a national model for doctor ranking programs. This model was created in consultation with, and is supported by, the American Medical Association and the Medical Society of the State of New York, along with a host of consumer advocacy groups including the Consumers Union and the National Partnership for Women & Families.

"Today's announcement is another important victory for consumer rights," said Debra Ness, President of the National Partnership for Women & Families. "Consumers need to be able to trust that their doctors are evaluated in a fair and accurate way and to know what factors go into their ranking system. All insurers that are considering tiering or ranking their doctors should be responsive to the needs of their consumers and adopt the full transparency and protections embodied in this agreement."

"Through this achievement, Attorney General Cuomo has provided consumers with an important resource for understanding how physicians are measured by participating health plans," said Lois Aronstein, AARP New York State Director. "Consumers need valid and reliable information to choose a doctor that meets their needs. 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."

"We applaud the Attorney General for his strong leadership and efforts to ensure that doctor ranking programs will provide patients with clear and comprehensive information, and that accurately reflect the quality of health care provided by doctors," said Dr. Robert Goldberg, President of the Medical Society of the State of New York. "Attorney General Cuomo's model also ensures transparency for both patients and doctors -- patients will now understand the criteria upon which doctors are ranked, and doctors will be able to provide input into the ranking system."

The model 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.

Attorney General Cuomo previously sent letters to CIGNA and Aetna, in addition to UnitedHealthcare, warning that their physician ranking programs were likely to confuse consumers. Earlier this month, Cuomo also issued letters asking Empire Blue Cross Blue Shield to justify its planned ranking program, Blue Precision, and calling on Preferred Care and HIP Health Plan of New York/GHI to refrain from launching similar programs without first providing details about their systems and getting prior consent of the Attorney General.

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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