Albany Leaders Want Cuomo's Doctor Rankings As Law
BY JOHN TOSCANO

The agreement worked out by New York Attorney General Andrew Cuomo and six of the major health insurers in New York state for a consumer friendly doctor ranking code is to be enacted into legislation under an agreement between Cuomo and legislative leaders in Albany.

The agreement worked out by New York Attorney General Andrew Cuomo and six of the major health insurers in New York state for a consumer-friendly doctor ranking code is to be enacted into legislation under an agreement between Cuomo and legislative leaders in Albany.

The comprehensive legislation agreed to by state Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver will be the first in the nation.

Cuomo said the code, based on input from the nation's leading physician and consumer advocacy groups, gives New York consumers added protections and should encourage all insurers to adopt similar principles of accuracy, transparency and oversight.

He added, "It's 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."

Silver, a Democrat, in joining in announcing the future legislation, 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."

Republican Senate Leader Bruno, noting that consumers "need all the information they can get" to select doctors and make critical healthcare decisions, said Cuomo's model ranking program will enable patients to make informed decisions about their physicians to ensure a high quality of care.

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 systems. In addition, under the Attorney General's 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.

Last week, Cuomo announced that six of the top health insurance companies in New York state and the nation agreed to adopt the Doctor Ranking Model Code in agreements signed with his office. Four of them, including the three largest insurers in the country, have agreed to apply the principles of the code nationwide.

The Doctor Ranking Model Code was 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 and Families.

The health insurance companies which have agreed to adopt Cuomo's Doctor Model Ranking Code are Cigna Healthcare, Aetna, Empire Blue Cross/Blue Shield, United Healthcare, Oxford Health Plans, Group Health Incorporated (GHI), Health Insurance Plan of Greater New York (HIP), and MVP Healthcare and its affiliate Preferred Health.