ATTORNEY
GENERAL CUOMO CALLS ON HEALTH CARE COMPANIES TO HALT
PLANNED DOCTOR RANKING PROGRAMS
DIRECTS
EMPIRE BLUE CROSS BLUE SHIELD TO DISCLOSE BASIS FOR
DOCTOR RANKINGS
Issues
Consumer Alert To New Yorkers about Potentially
Deceptive Programs
NEW
YORK, NY (Oct 18, 2007) – In an expanding industry-wide
investigation, New York Attorney General Andrew M. Cuomo today
issued letters to Empire Blue Cross Blue Shield, Preferred Care,
and HIP Health Plan of New York/GHI requesting information on
the insurers’ doctor ranking programs. The Attorney General
also alerted New Yorkers about potentially deceptive programs
driven by financial motives and not consumers’ best interests.
“Consumers
need to be aware that doctor ranking programs as currently
designed may steer patients to the cheapest, but not necessarily
the best doctors, letting profits trump quality,” said
Attorney General Andrew Cuomo. “Transparency and accurate
information are critical when making health care decisions and
should not be clouded by conflicts of interest.”
In
the three separate letters sent today, Attorney General Cuomo:
Requested
New York City-based Empire
Blue Cross Blue Shield to justify
its existing ranking program known as Blue
Precision, currently offered to
national employers in New
York City.
Directed
Rochester-based Preferred
Care to halt the launch of its
planned doctor ranking program and to provide details about
the system.
Warned
New York City-based HIP
Health Plan/GHI to refrain from
launching such programs without the prior consent of the
Attorney General.
In
the letter to Empire Blue Cross Blue Shield, serving
approximately 533,271 members across New York
State, Cuomo also questioned Blue
Precision’s strategy to steer consumers to
preferred doctors. In a publicly available presentation
outlining the program, Empire describes its “sanction” model
which pressures consumers to switch doctors by imposing
financial penalties.
Blue
Precision is expected to be operating in
22 states by 2008. The program is already available to national
employers such as Wal-Mart, which has deployed the program in
Florida.
“When
making healthcare decisions, it is vital consumers have as much
honest information and unfiltered advice as possible,” said
Cuomo. “Ranking systems are in their infancy. Consumers should
use caution and have an open dialogue with their doctors.”
In
the letter to Preferred Care, serving approximately185,188
members across New York State, Cuomo also cited
concern about the insurers’ "report cards," which
include a measure of patient satisfaction based in large part on
cost criteria.
Attorney
General Cuomo is scrutinizing the emerging national trend of
physician ranking programs in an effort to ensure consumers are
protected. Similar letters have been sent to UnitedHealthcare,
Aetna Health Plan, and Cigna in recent weeks, and discussions
with these companies are ongoing.
For a complete list of county-based enrollment data, visit: http://www.health.state.ny.us/health_care/managed_care/report/2005/2005complete.pdf
Copies of the letters are available at www.oag.state.ny.us.
___________________________________________
"The
New York Parent Education and Awareness Program
How the Court System is Succeeding in Protecting Children Whose
Parents are Going Through Divorce, Separation or Other
Child-Centered Litigation"
New York State’s
Chief Judge, Judith S. Kaye, announced in her 2001 State of the
Judiciary Address an initiative to institutionalize parent
education for separating and divorcing parents. A
19-member advisory board was created to oversee this process.
The Advisory Board is comprised of individuals from across New
York State and includes representatives in the fields of
pediatrics, child psychiatry and psychology, social work, and
family life science, as well as a matrimonial attorney and law
guardian, and Family Court, Supreme Court and Appellate Division
judges.
What is the New
York State Parent Education and Awareness Program? It is a
program designed to educate divorcing or separating parents
about the impact of their breakup on their children. The primary
goal is to teach parents ways they can reduce the stress of
family changes and protect their children from the negative
effects of ongoing parental conflict in order to foster and
promote their children’s healthy adjustment and development.
Why have this
program? You do not have to know someone who is undergoing a
separation, divorce or other child-centered litigation, you do
not have to experience it yourself, nor do you have to view the
recent film, "Squid and the Whale" to recognize that
putting children in the middle of the adult conflict can be
detrimental to their health and well-being.
Studies have long
documented an increased risk of adverse outcomes for children
subject to their parents’ conflict including poor
psychological adjustment, more behavioral problems, higher
utilization of mental health services as adults, higher rates of
disruption in their own marriages, to name but a few.
However many parents have not been educated about these issues,
and some, despite their awareness, cannot change their behavior
because they do not have the tools to do so. Experience
has shown that if parents are educated to understand the
psychological and legal process they are undergoing, the
outcomes are more positive for all involved.
How does this type of behavior
play out in the matrimonial and family court case’s judges
preside over throughout the State? The Hon. Evelyn Frazee,
Chair of the New York State Parent Education and Awareness
Program’s Advisory Board tells a story from her own
experience.
"I have seen too many
children adversely affected by their parents’ conflict
from the extreme of a case in which a 12-year-old boy tried
to commit suicide because he felt inextricably trapped in
his parents’ war with each other to the commonly seen
symptoms of depression or withdrawal, decline in school
performance, somatic symptoms such as headaches and
stomachaches, involvement in unhealthy activities (acting
out) such as drinking, drugs and promiscuous sexual
activity. And then, of course, there are my adult
friends who have had and continue to have what should be
happy life events for them-graduations, weddings, birth of a
child, holidays-marred or turned into stressful events
because their parents are still at war and cannot focus on
their child’s needs or interests."
How do I learn more about the
Parent Education and Awareness Program? Following the guidelines
developed by the Advisory Board, the Office of Court
Administration certifies and monitors local providers of such
services who wish to accept court-referred participants. The New
York State Parent Education and Awareness Program has a website
at www.nycourts.gov/ip/parent.
It contains the guidelines and procedures for certification and
the forms required for providers. A list of certified
parent education providers can also be found on the website.
There are currently 48 certified parent education providers in
38 counties offering classes in 58 locations. There are
guidelines for courts to provide assistance in referring parents
to parent education programs. Trainings, which are
available on video, have been conducted with parent education
providers and judges.
Conclusion
This is just a
brief overview of the current status of the New York State
Parent Education and Awareness Program. Experience and research
have shown that parent education does make a positive difference
for children and their parents who are experiencing divorce or
separation and it can help bring about a reduced need for court
intervention. In addition to judges making referrals,
individuals can self-refer to these programs, and attorneys can
refer their clients to them. Currently, parent education is
available in 38 counties. We are working to make parent
education available in the remaining 24 counties in New York
State. If your county or area does not have a parent
education program and you have some suggestions as to potential
providers, you can contact the Program by e-mail at nyparent-ed@courts.state.ny.us
or at the toll-free number at 888-809-2798, or by mail at the
Parent Education Board, 140 Grand Street, Suite 701, White
Plains, New York 10601. Also, you can locate information about
parent education at the parent education website at www.nycourts.gov/ip/parent-ed.
Please "get the word out" about this valuable
resource.
___________________________________________
New
York Physician Alliance
In
2005 state legislation created a Pay for Performance (P4P)
Demonstration program to facilitate multi-payer
collaborative. The statute directed the Commissioner of
Health to convene a workgroup of providers and payors to
develop a list of clinical measures and metrics to measure
provider performance. The New York Quality Alliance (NYQA)
is the statewide multi stakeholder collaborative developed
as a part of the DOH grant, and is responsible for
developing a uniform data aggregation and reporting process
that will promote statewide quality performance improvements
among health care practitioners. The Physicians’ Alliance
(PA) is the group of physician representatives organized to
oversee the project from a physician’s perspective. An
update on the PA was distributed in the first Physician
Alliance Newsletter, and further information is
available on the NYQA web
site.
Dietary
Substances Containing Ephedra Banned from Sale in New York State
The Legislature’s
passage of Assembly Bill 6921C/Senate Bill 3294B, sponsored by
Assemblywoman Audrey Pheffer and Senator Charles Fuschillo,
would ban the sale of dietary supplements containing ephedra in
New York State. Governor George Pataki is expected to sign this
measure. This issue has received increased attention by the
Legislature this year as over 100 deaths have been attributed to
the use of ephedra in dietary supplements. The Medical Society
of the State of New York supported this measure and participated
recently in a press conference Senate Majority Leader Bruno and
Sen. Fuschillo. In May, the Medical Society also participated in
a roundtable held by members of the Assembly. Over 3,000 Adverse
Events Reports (AERs) have been reported to the Food and Drug
Administration regarding ephedra based supplements. Since
ephedra is classified as a dietary supplement instead of a drug,
it has been difficult for the FDA to regulate the substance
despite the reports of serious side effects including seizures,
heart attacks and brain hemorrhage.
Legislation Establishing Childhood Obesity
Prevention Program Passes
Legislation, which
would establish a childhood obesity prevention program within
the Department of Health, passed the New York State Legislature
this week (June 16-21). The measure, Assembly Bill 2800A/Senate
Bill 2045A, sponsored by Assemblymember Felix Ortiz and Senator
Mary Lou Rath, directs the Department of Health to establish a
prevention program within the department with an emphasis on
preventing and reducing the incidence and prevalence of obesity
in New York State’s children and adolescents. Under this
measure, the Department of Health would be responsible for
developing media campaigns, sponsoring periodic
conferences/meeting to discuss nutrition and exercise and
helping communities to develop programs that involve caregivers
and parents. The bill now goes to the Governor for his
signature.
Health
Workforce Recruitment and Retention Act
The multibillion-dollar health
care deal was enacted during the early morning on January 16,
2002, in great haste and secrecy without any public hearings, no
experts testifying on the proposal and with few rank and file
legislators involved in the negotiation process. It was a
classic back room deal.
Hospitals are slated to get about
$700 million in state money over the next three years to boost
salaries and take other steps to recruit workers. Money for
hospitals and nursing homes will be distributed evenly to
institutions across the state, based on the size of their
payrolls, and may be used for recruiting or retaining any
non-supervisory personnel.
Hospitals will receive $696
million over three years to be used for recruitment and
retention activities of which $651 million will be
distributed as a Medicaid rate add-on unique to each
facility and $45 million will be allocated over three years
as a competitive recruitment and retention grant program for
hospitals.
Nursing homes will receive
$288 million over three years via a similar Medicaid rate
add-on unique to each facility. A nursing home grant program
to enhance quality of care through improved staffing would
add another $62 million per year for three years. Nursing
homes demonstrating financial need may qualify for
additional grant funding totaling $30 million over three
years.
Home care will receive- $964
million over four but $895 million of it will go to New York
City's home attendant program
The Campaign for Healthy Children
was successful in advocating the following program
simplifications in the Child Health Plus A and B programs which
were included in the bill.
Mail in renewals for children
in Child Health Plus A (children’s Medicaid) program.
Self-attestation of income for
children renewing in CHP B.
A new simplified renewal form
for CHP A and B.
Elimination of the
documentation requirement for social security numbers.
Providing a two-month grace
period for completion of paperwork for CHP B renewals.
The legislation also includes funds for:
the creation of a foundation
dedicated to improving health care access for New Yorkers;
community health centers;
prescription drug coverage for
low-income seniors;
expanded Medicaid coverage for
the disabled; and
excess malpractice insurance
for doctors.
To pay for these programs the
legislation:
hikes cigarette taxes by 39
cents per pack, to a total of $1.55; generating an estimated
$789 million over three years;
extracts an estimated $1
billion from the conversion of Empire Blue Cross & Blue
Shield to a for-profit company;
imposes a 6 percent surcharge
on nursing home revenues to raise $300 million a year; and
anticipates a federal Medicaid
formula increase from 50% to 53% generating $1.8 billion
more in federal Medicaid money.
The administration did not put a
price tag on the bill but estimates range from $3.5 billion to
$4.5 billion over an uncertain number of years. The bill was
passed because of the enormous political clout of Dennis
Rivera, the head of SEIU 1199 health care workers union in New
York City.