Ranking of Doctors by Insurers


5000 Post Club
Interesting article. I understand that recently a similar letter from New York AG Cuomo was sent to both Aetna and Cigna addressing this subject.http://www.blueridgenow.com/section/WEATHER

Published Saturday, July 14, 2007
N.Y. Attorney General Objects to Insurer’s Ranking of Doctors by Cost and Quality


In a sharply worded letter, the New York State attorney general’s office asked a health insurance company yesterday to halt its planned introduction of a method for ranking doctors by quality of care and cost of service, warning of legal action if it did not comply.

The letter was addressed to Thomas J. McGuire, a senior lawyer in Hartford for UnitedHealthcare, a unit of UnitedHealth Group in Minneapolis.

It asked the company to cancel its plan to release the rankings in September, citing a furor over a similar program’s introduction in Missouri in 2005. There, physician groups, including the American Medical Association, said the cost rankings primarily reflected the cost of care to the insurer — not to patients.

Missouri doctors cited numerous objections to the pilot program, which was halted and is being redesigned. For example, most faculty members of the Washington University School of Medicine in St. Louis were initially excluded from the quality rankings because university-based care is generally more expensive. Doctors in major specialties were ranked by cost alone.

Tyler Mason, a spokesman for UnitedHealthcare, said the company had been meeting with the attorney general’s staff. He said: “We share their commitment to looking at cost and quality. That’s exactly what this is about. The assertion in the letter that sometimes higher cost equals higher quality is actually not what experts nationwide find. Sometimes lower cost means higher quality.”

He responded to criticism in St. Louis by saying that the shelved program measured quality. “You don’t even get to the cost factor if you don’t meet the quality threshold,” he said. Similar programs are “working in 94 markets across the country.”

Linda A. Lacewell, a senior lawyer in the office of Attorney General Andrew M. Cuomo, wrote in the letter that the ranking would apparently be used to steer consumers toward selected doctors. “To compound the situation,” she wrote, “we understand that employers may act on these ‘ratings’ to offer financial inducements such as lower co-payments or deductibles to promote ‘cost-effective’ doctors to their employees.”

Ms. Lacewell said patients might be steered toward doctors based on flawed data and UnitedHealthcare’s “profit motive.” She wrote, “Consumers may be encouraged to choose doctors because they are cheap rather than because they are good.”

In a telephone interview, Dr. Stephen G. Slocum, an ophthalmologist who is president of the St. Louis Metropolitan Medical Society, said the Missouri program was “absolutely terrible.”

He added: “It was dishonest. They were telling people that it was a quality metrics program when they were really just measuring cost.”

And, he said, his criticism was not just sour grapes. “I had a star next to my name; I was preferred,” he said. “But it didn’t mean anything.”