The Academy of Medicine of Cleveland & Northern Ohio (AMCNO) Applauds Passage of Legislation to Address Physician Ratings 

After several months of working with AMCNO leadership and other interested parties including the Ohio Department of Insurance, the Ohio Attorney General, medical organizations, and the health insurance industry; HB 122, introduced by Representative Barbara Boyd, Chair of the Ohio House Health Committee (D-9 –Cleveland) has successfully passed in the Ohio House of Representatives. 

This legislation - meant to address the issue of physician ratings by insurance companies in Ohio will now move into the Senate for further debate. A companion bill - SB 98, sponsored by Senator Tom Patton (R – 24 – North Royalton) is also under review by the Ohio Senate. The AMCNO worked with Senator Patton on the introduction of this legislation as well and the AMCNO provided proponent testimony this week on the bill to the Senate Insurance, Commerce and Labor Committee. 

The purpose of this legislation is to provide patients with accurate information when selecting a physician. This legislation would prevent health insurance companies from ranking physicians based solely on specific criteria to persuade a consumer to choose one physician over another. The designations would be made based on cost efficiency, quality of care or clinical experience. This legislation will establish standards for the physician designations. It stresses that health plans must use risk-adjusted data, base grades, and ratings at least in part on nationally recognized quality of care measures. The legislation also allows physicians the right to review and appeal their ratings prior to the ratings being released to the public. 

In 2007, the New York Attorney General became active on the issue of insurance company doctor ranking programs. Pursuant to that New York activity, an agreement was reached by physician groups and health insurers to develop national standards that the companies will use to rate physician performance. That agreement protects the rights of health care consumers and has support from various medical groups, insurers and business groups.

Legislation was introduced and passed in Colorado that embraces many of these principals. At the request of the Academy of Medicine of Cleveland & Northern Ohio, Rep. Boyd had the Colorado legislation drafted and introduced here in Ohio as HB 122. HB 122 provides that no designation or change in designation can be made without notification to the physician. Then, no publication can be made until at least 45 days has passed. That period of time is longer if the physician has indicated a desire to appeal. Once an appeal begins, it must be resolved within 90 days. 

The legislation stresses that health plans must use risk-adjusted data, and base grades and ratings at least in part on nationally recognized quality of care measures and not on cost alone. The legislation also provides physicians with the right to review and appeal their ratings.

Listen to Dr. Bastulli discussing HB 122 on the award-winning AMCNO Healthlines radio program –  click here