New York agreement refines doctor-rating criteria

Physician organizations hope a deal between Cigna and the New York attorney general's office will inspire other plans to ditch cost-based doctor rankings.

By Emily Berry, AMNews staff. Nov. 19, 2007.

An agreement that was struck between a health plan and regulators in New York won't stop insurers' use of physician rankings, but it might make them more acceptable to doctors.

Cigna and New York Attorney General Andrew Cuomo's office on Oct. 29 struck an agreement that requires the insurer to submit to the state the rating criteria it plans to use to place doctors in tiered networks, in which members pay a lower co-pay or otherwise get discounts for seeing favored physicians. Cigna is one of many health plans that have received letters from Cuomo's office stating that its physician-rankings plan might be misleading to consumers because, in part, it appeared to focus on cost more than quality.

The rankings plan Cigna adopts must use independently accepted criteria -- not claims data -- to rate physicians on quality measures without taking cost into account. Physicians also would get the chance to see those criteria and appeal their rating.

Cigna Senior Vice President and Chief Medical Officer Jeffrey Kang, MD, MPH, called the agreement a "national model for the entire health insurance industry." Robert Goldberg, DO, president of the Medical Society of the State of New York, called the deal a "milestone in assuring that patients have a prime role in selecting physicians based on what is important to their personal health care needs."

"The attorney general struck what is a good balance between the needs of patients, the rights of physicians and, frankly, the needs of health plans as well," said American Medical Association President-elect Nancy H. Nielsen, MD, PhD, an internist in Buffalo, N.Y. Dr. Goldberg and Dr. Nielsen appeared with Cuomo at a New York news conference announcing the deal, and their organizations assisted the attorney general's office in its investigation.