N.Y. warns more insurers about physician ratings programs

About a month after threatening UnitedHealthcare with a lawsuit if it moved ahead with its physician ratings program, the New York attorney general's office has sent letters to Cigna and Aetna stating its concerns about those plans' physician rankings.

The letters, sent Aug. 17, state that information on the companies' Web sites about their physician ratings programs raise the possibility that the programs are "ill-designed" and "carry a significant risk of causing consumer confusion, if not deception." The letters fault the companies particularly for their apparent use of claims data to determine physician quality, an insurer practice that has been criticized in the past by the American Medical Association, among others.

The letters also criticize the plans for not stating exactly what factors go into choosing which physicians are considered high quality. In each case, plan members affected by the programs, Cigna Care Network and Aetna's Aexcel, would pay more out of pocket for physicians who do not meet the programs' standards.

In each case, the attorney general's office asked Cigna and Aetna to provide data detailing how it determines its physician ratings and how it markets these programs to physicians and patients, and to provide any complaints filed by patients, physicians and other health organizations, among other documents.

The plans say they are cooperating with the attorney general's office. The letters ask the plans to respond "expeditiously" but do not give a specific deadline. The letters also do not state that the attorney general's office believes unequivocally that the Cigna and Aetna programs violate state law, though the letters leave open that conclusion, pending further investigation.

In response to the attorney general's threats to sue UnitedHealthcare if it implemented its physician ratings network, the company has sent back documentation intended to address the concerns of the attorney general's office and says it plans on starting its network in October.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/09/03/bibf0903.htm.