NY AG sends warning to Cigna & Aetna for physician ranking programs

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New York Attorney General Andrew Cuomo warned health insurers Aetna and Cigna Healthcare that their physician ranking programs, as they are currently designed, could potentially confuse or even deceive consumers. Cuomo expressed his concern over the design of the programs and requested a full justification in two letters sent to the insurers.

“Transparency and accurate information are essential when consumers make healthcare decisions,” said Cuomo. “We will ensure that insurance companies are not obscuring important facts at the consumers’ expense.”

In a letter to Cigna, which mimicked a letter sent last month to United Healthcare, the attorney general stated that his office had three principal concerns:

  • Consumers may be steered to doctors on faulty data and criteria.
  • Consumers may be encouraged to choose doctors because they are cheap rather than because they are good. This could undermine the integrity of the doctor-patient relationship.
  • Profit motive may affect the accuracy of its quality rankings because high-quality doctors may cost the insurer more money. This is a conflict of interest

In particular, the office of the attorney general criticized Cigna and Aetna for designating specialists based on claims data, which carries several significant risks of error when used to rank individual physicians; the insurers do not disclose the accuracy rate of their rankings; and insurers have a profit motive to recommend doctors who cost less, not necessarily those who are most qualified.

Cuomo said he has been closely observing the national trend of physician ranking programs with an eye toward protecting consumers.  The Attorney General and United Healthcare are currently involved in discussions about that program, scheduled to be introduced in October 2007.