Agreement gets physician rating system to focus on quality, not cost

January 1, 2008

After New York Attorney General Andrew Cuomo launched an investigation last year to determine whether health plans mislead patients into believing that their physician rating systems were based on quality standards rather than cost, at least one insurer has struck a deal.

After New York Attorney General Andrew Cuomo launched an investigation last year to determine whether health plans mislead patients into believing that their physician rating systems were based on quality standards rather than cost, at least one insurer has struck a deal. Cigna, while admitting no wrongdoing, would be allowed to go forward with its tiered network. The catch: It must disclose to the state the "independently accepted criteria" it plans to use to rate physicians; this criteria must rate physicians on quality measures, not cost; and physicians must be allowed to review the data and appeal their ratings.

The deal has been touted as a "milestone in assuring that patients have a prime role in selecting physicians based on what is important to their personal health care needs," Robert Goldberg, DO, president of the Medical Society of the State of New York, told American Medical News (11/19/2007).

Other insurers-including Aetna, UnitedHealth Group, and WellPoint's Empire BlueCross BlueShield subsidiary-plan to work with the attorney general's office under similar frameworks or have decided to change their physician rating systems. Physician organizations will keep a close eye on Cigna as it works out the details of its tiered network to keep in compliance with the agreement.