AMCNO Spearheads Legislation to Address Physician Ranking in Ohio

After several months of working with the AMCNO leadership and lobbyists, Senator Bob Spada (R-24) has introduced SB 355. 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 solely based 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.

The issue of physician ranking has been hotly debated for several years. The crux of the debate is balancing the rights of physicians to have accurate and relevant reporting of their practice with the desire of health insurers and consumers to have access to information about their treating physician. 

In 2007, the New York Attorney General became active on the issue of insurance company doctor ranking programs. In 2007, New York State Attorney General Andrew Cuomo reached agreements with insurance companies operating in New York to provide members with more information on how companies rank physicians. Cuomo said the deal could set a national standard for physician ranking systems. Cuomo warned insurance companies that their physician ranking programs likely would confuse or mislead members because of problems with the information used to rank physicians. Under the agreements, the plans will divide their preferred physician list into three lists -- one that ranks by cost, one that ranks by quality and one that uses a combination of both measures. The agreements also require that the plans report to the NY Attorney General every six months and use an outside monitor. 

The AMCNO along with other medical groups including the American Medical Association have expressed concern that doctor rankings can be confusing and could be used to steer patients to the least-expensive health care providers, rather than being based on quality. It is important that the insurance companies are truly reviewing quality issues versus cost and claims data, and the data must be accurate with the ability of physicians to appeal their data. 

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.