New York Attorney General Cuomo has threatened to obtain an injunction to prohibit the introduction of UnitedHealthcare’s “Premium designation” program, which identifies physicians who follow certain quality of care and efficiency criteria. Doctors that meet the criteria for quality of care are assigned one star; if they also qualify for efficiency of care, they are assigned two stars. Cuomo stated that the star rankings would have “a strong likelihood of causing consumer confusion, if not deception,” and was further concerned that (a) the criteria used might be faulty, (b) consumers would be encouraged to use cheap doctors rather than good doctors, and (c) UnitedHealthcare’s profit motive “may” affect the accuracy of its quality rankings. Cuomo felt that the profit motive was a conflict of interest, because high quality physicians cost more.
The New York Attorney General’s letter alluded to problems UnitedHealthcare experienced with a different version of the program that was rolled out in St. Louis that some, including the Colorado Medical Society, have claimed severely damaged physician relationships with UnitedHealthcare. See Colorado Medicine, August/September 2005, “United Premium Designation Program” at 176. It appears that the program has been modified since that point and is currently operating in several states. According to UnitedHealthcare, a 2005 study of cardiovascular surgeons showed that physicians not designated under the UnitedHealth Premium program had 70 percent higher complication rates and twice the number of surgical readmissions when compared to surgeons with UnitedHealth Premium quality and efficiency designations. See UnitedHealthcare SEC Form 8K filed December 2006. On average, cardiovascular surgeons with UnitedHealth Premium quality and efficiency designations deliver savings of approximately 20 percent per episode of care. Id. Issues regarding how best to evaluate providers based on quality and efficiencies will continue to be discussed as transparency initiatives are rolled out across the U.S.