Efforts by health insurers to rank doctors may become less controversial and more understandable to consumers under an agreement signed Monday by insurer Cigna ci and New York Attorney General Andrew Cuomo.
Cigna agreed to make public how it ranks doctors, won't evaluate its physicians on cost alone and will allow an independent national standard-setting organization to review its efforts every six months.
The agreement, believed to be the first of its kind nationally, should spur other insurers to take similar steps, said a coalition of consumer and employer groups who helped advise Cuomo's office on the agreement.
The agreement comes amid growing interest by insurers in ranking doctors and increased demand from employers and consumer groups for more information about doctor cost and quality. Last week, WellPoint wlp announced it had teamed with Zagat Survey to do a consumer-oriented ranking of doctors, similar to the familiar restaurant guides produced by Zagat.
The types of programs that raised concern with Cuomo's office involved ranking doctors based on medical claims data and other information. Six months ago, his office launched an investigation into the practice and has sent letters to Aetna aet, Cigna, UnitedHealth unh and other insurers seeking more information and warning that the programs may violate consumer laws.
"A carefully designed physician-ranking program can provide valuable information to consumers. … However, an ill-designed program risks confusing or even deceiving consumers," said a recent letter from the New York attorney general's office to an insurer seeking more information on its program.
Doctor-ranking efforts launched by insurers in many states in recent years often create special "networks" of preferred doctors. Patients are sometimes given financial incentives to choose doctors from preferred lists. Doctors often oppose such rankings, questioning whether they fairly consider a doctor's overall performance, and lawsuits have been filed by doctors against insurers over the practice.
But on Monday, Nancy Nielsen, president-elect of the American Medical Association, lauded the agreement, saying it renounces "physician rankings based solely on economic factors" and provides a "balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician."
Under the agreement, Cigna will disclose to doctors and consumers exactly how they assign doctors a ranking, what percentage of their decision is based on cost and what percentage is based on measures of quality. Doctors will be able to review and appeal their rankings.
Several insurers that operate in New York said existing or proposed doctor-ranking efforts already incorporated many of the terms of the agreement.