Aetna Reaches Agreement With New York State On Physician Ranking System, Transparency

Main Category: Primary Care / General Practice
Also Included In: Health Insurance / Medical Insurance
Article Date: 15 Nov 2007 - 8:00 PDT

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Aetna on Tuesday announced it has reached an agreement with New York state attorney general Andrew Cuomo (D) to change its physician ranking system to reflect nationally accepted standards for quality of care and to make transparent the criteria used for evaluation, the Wall Street Journal reports (Bray, Wall Street Journal, 11/14). The deal concerns Aetna's Aexcel network of physicians, which carries a lower cost for enrollees than Aetna's larger network.

Cuomo, who in October reached a similar agreement with Cigna, has raised concerns that consumers have trouble interpreting insurer rankings of physicians. According to the Aetna agreement, Cuomo believes that "profit motive may affect (an insurer's) program of physician measurement and/or reporting," adding, "This is a potential conflict of interest, and therefore requires scrutiny, disclosure and oversight by appropriate authorities."

Aetna will disclose to consumers how it uses performance quality and cost-efficiency when deciding whether a doctor is included in Aexcel. Physicians not included in Aexcel will be allowed to apply for reconsideration (Levick, Hartford Courant, 11/14). As part of the agreement, Aetna will hire an independent monitor to review its adherence to the agreement and report to Cuomo biannually (Reuters/Los Angeles Times, 11/14).

Comments
Troyen Brennan, Aetna's chief medical officer, in a written statement said, "We are committed to providing our members with a physician performance evaluation program that is easy to understand and takes into account the input of participating physicians."

The agreement was praised by American Medical Association President-elect Nancy Nielsen, who said that insurers' evaluations of doctors "can be skewed through the use of economic criteria, insufficient sampling of patient cases, questionable quality measures and poor adjustments for risk" and "can mislead patients and erode confidence and trust in physicians, and disrupt patients' longstanding relationships with physicians who have cared for them for years" (Hartford Courant, 11/14).

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