Cuomo legislation earns backing

By John O'Brien | Nov 26, 2007


NEW YORK - New York Attorney General Andrew Cuomo says he will have a little help when he attempts to turn his investigation into doctor-ranking systems into legislation.

Cuomo claimed Monday that state Senate Majority Leader Joseph Bruno and Assembly Speaker Sheldon Silver will support the legislation he has designed aimed at reforming doctor-ranking practices by health insurers.

"The legislation will codify the Doctor Ranking Model Code, which protects consumers and sets a standard for all insurers to meet," Cuomo said. "It is 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."

Cuomo has settled with several insurers after alleging that their ranking systems are potentially deceptive and not in the consumers' best interests. He says they may let "profits trump quality."

His legislation is similar to settlements reached with insurers like WellPoint, Inc., UnitedHealth Group Inc., and Cigna Corp. It is designed to ensure that doctor rankings are not based solely on cost.

Earlier this year, the state's Legislature passed Cuomo's Student Lending Accountability, Transparency and Enforcement Act (SLATE) after Cuomo's investigation into the student-lending industry.

Cuomo said he worked with the American Medical Association, as well as other consumer and medical groups, when creating the doctor-ranking legislation.

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

If passed, the legislation will force insurers to:

-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; and

-Nominate and pay for the Rx who will oversee compliance with all aspects of the new ranking model.

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