New York warns of lawsuit over physician rankings by United

UnitedHealthcare is going ahead with plans to release its physician rankings for the New York area, despite a threat of legal action from the state's attorney general, a United spokesman said.

However, the company is delaying implementation of the rankings system for a few months so physicians can get more familiar with it -- a move United says has nothing to do with the attorney general's threat.

United will roll out its Premium program -- a physician evaluation system based on cost and quality-of-care data -- in the New York area, including New Jersey and Connecticut, at the end of the year, said United spokesman Tyler Mason. The health plan already uses the program in 100 other markets, he said.

A July 13 letter from the attorney general's office said the ranking system would influence patients to use physicians who are cheaper but not necessarily better. The letter told United it would face legal action if it released the rankings as planned at the end of July.

Mason said United will release the rankings at the end of the year, and added that the delay is not because of the letter, but because the plan had already decided to give physicians more time for input and review.

"It's a national trend," Mason said. "All health plans are engaged in this type of activity. The need for consumers to have information as they pick up a larger share of their health care costs is here. So to the degree [the state is] contending [the rankings] could cause confusion, we obviously disagree with that."

In 2005, the largest health system in St. Louis, BJC Healthcare, threatened to drop United when the plan released the pilot version of the ranking program in Missouri. The American Medical Association and several other societies opposed the program, which United is revising, including allowing more physician input as to what data would be used.

J. James Rohack, MD, a Temple, Texas, cardiologist and a member of the AMA Board of Trustees, said most physicians are still wary of ranking programs. In most cases, plans post on their Web sites physicians' names and whether they are considered preferred doctors. Plan members who choose higher-ranked doctors might get a reduced co-pay, or be able to join a tiered network in which they would pay lower premiums in exchange for seeing only higher-ranked physicians.

"The physician community is very concerned that in an attempt to control cost, under a guise of improving quality, insurance companies are creating ranking programs that are just purely cost-based," Dr. Rohack said. "If I have a person who's age 50 with a history of colon cancer, the treatment should be to order a colonoscopy. If I'm being measured against another physician who doesn't order the colonoscopy, to the insurance company I would be a bad doctor because I cost more."

Donald Moy, general counsel for the Medical Society of the State of New York, said the society told the attorney general's office it had similar concerns about United's program.

"That's not only a harm to physicians who are incorrectly ranked, but it's also a harm to the public," he said. "They're told they're being steered to doctors on the basis of quality when in reality it's possible they're steered on the basis of cost."

Moy said New York state laws require health plans to consult physicians when developing ranking methods, to inform the physicians of the data used in the rankings, and to prove they're comparing physicians with similar physicians, based on patient populations.

He added that the health plans should have to show they're complying with those laws.

"It should not be up to the medical society, the AMA or the regulatory bodies to expend resources to study these methodologies and prove they're invalid," he said. "It should be the burden of these plans that they are doing what they claim they're doing."