School of Nursing Researcher Will Help Develop New Insurance Database

Oct. 28, 2009
Irena Pesis-Katz, Ph.D.

University of Rochester School of Nursing faculty member Irena Pesis-Katz, Ph.D., yesterday was named to the newly created research network that is part of New York State Attorney General Andrew Cuomo’s nationwide reform of the consumer reimbursement system for out-of-network health care charges.

Speaking at the University of Rochester Medical Center Oct. 27, Cuomo provided details about the upstate research network and a new not-for-profit company, FAIR Health, Inc. Together these entities will develop an independent database for consumer reimbursement and a new website where, for the first time, patients around the country can find out in advance how much they are likely to be reimbursed by their insurance companies for out-of-network health care services.

In addition to the University of Rochester, the upstate research network includes the State University of New York at Buffalo, Cornell University, SUNY Upstate Medical University, and Syracuse University, which will serve as headquarters for the research efforts.

Cuomo’s announcement Tuesday follows an investigation by his office into how the health insurance industry reimburses consumers for out-of-network health care charges. Almost $100 million in settlement money from health insurers will fund the new reimbursement system which Cuomo promises will bring transparency, accountability and fairness to the consumer reimbursement system.

“I applaud Attorney General Cuomo’s efforts to ensure that patients and families are treated fairly and given access to information they need when it comes to out-of-network reimbursement,” said University of Rochester President Joel Seligman. “We are excited to play a role in this initiative and look forward to having the University of Rochester’s School of Nursing and researcher Irena Pesis-Katz being integral members of the FAIR team.”

Pesis-Katz has spent her career working collaboratively on research activities designed to produce and evaluate evidence-based quality improvement programs for the community. As a member of the new research consortium, she expects to establish the methodology to calculate the new usual and customary rates, provide expertise in using and analyzing claims data, and assess the impact of the new rates on utilization of out-of-network services and their costs.

“I am very excited to be a part of this team led by Dr. Deborah Freund from Syracuse University,” said Pesis-Katz. “This is a wonderful chance for me to be involved in research efforts that immediately affect practice while benefiting consumers. I also think it’s a valuable opportunity for the School of Nursing to play a leadership role in this important aspect of health care reform.”

A native of Israel, Pesis-Katz earned a bachelor’s degree in health systems administration from the University of Ben-Gurion in the Negev and her doctorate in health services research and policy from the University of Rochester. While her previous research has focused largely on outcomes-based quality improvement programs evaluations, she also studies the economic impact of palliative care consultations in acute-care settings, and the role of quality of care in consumers’ choice of nursing homes.

In addition to her School of Nursing role, Pesis-Katz holds a secondary appointment in the University of Rochester Medical Center’s Community and Preventative Medicine department.

A resident of Brighton, she is a member of several professional organizations including the Gerontological Society of America, the Academy of Health Services Research and Health Policy, and the American Public Health Association.