NY Attorney General Questions Insurer’s Health Care Ranking Methodology

NY State attorney general Andrew Cuomo has come out against the use of claims data for ranking doctors.

In letters to Aetna and Cigna, Cuomo questioned the insurers’ use of claims data to rank specialists. According to Cuomo, claims data does not contain complete information and can skew rankings. He also criticized the insurers for failing to disclose the accuracy of the rankings and said insurers “have a profit motive” to recommend physicians who cost less but might not be the most qualified. Cuomo asked Aetna and Cigna to provide details about the criteria they use to rank doctors, how the insurers measure a physician’s performance and what incentives are used to steer patients to or away from providers.

He’s right. Here are just a few of many examples of how use of claims-based ranking data was found to be erroneous for docs in our institution:

• A woman who is rubella immune comes to see an ob-gyn for her third pregnancy. The doc is dinged by the insurer for not doing a rubella titer, since no claims were submitted for this test. The fact was that the patient already had immune titers in her prior two pregnancies and did not need this test done a third time.
• The insurer claimed a doc did not refer for BMD testing. It had already been done the prior year when she was covered under another insurance plan
• Insurer claimed no pap was done. It was done, but for some reason a bill was never submitted by the outside lab.

It’s as if Zagat decided they were going to rate restaurants by looking at the bill…