Business First of Columbus - January 12, 2009
http://columbus.bizjournals.com/columbus/stories/2009/01/12/story9.html

Friday, January 9, 2009

Payment hassles trump rate battles in docs’ satisfaction with insurers

Business First of Columbus - by Carrie Ghose

Health reformers who want to trim inefficiency could do well to take a few whacks at the administrative overhead required by insurers, says the head of the state’s trade group for practice and hospital administrators.

“The whole process is a moving target with multiple and varying sets of rules,” said Todd Fowler, president of the Medical Group Management Association of Ohio.

“It really shouldn’t be a battle between the provider and insurance company. It’s the patient that often gets caught in the middle,” said Fowler, an assistant administrator at the Jackson office of the Holzer Clinic, a southeast Ohio multispecialty practice.

To get a handle on the hassles, the trade group conducted a fall survey measuring satisfaction with insurers by polling its members and those of the Ohio State Medical Association, a physicians’ trade group. The responses released this month from the nonscientific, Web-based questionnaire provide tips for working with insurers, said Cathy Costello, the medical association’s director of practice economics and policy.

Results also will form discussion nuggets for an annual spring conference for physicians and insurers that’s hosted by the two trade groups.

“This meeting is not intended to be contentious,” Fowler said. “It’s intended to be educational from both sides.”

The survey is statistically insignificant because it had about 80 respondents, said Kim Ashley, spokeswoman for Anthem Blue Cross and Blue Shield in Ohio, in an e-mail to Columbus Business First.

“We do not believe this is representative of the over 9,500 doctors who are part of our Central Ohio network alone,” she wrote.

But business managers who participated could represent thousands of physicians, therapists and others, said Leah Cohen, Midwest lobbyist for the national Medical Group Management Association, which conducted similar surveys on Medicare and the five largest private insurers in each state and also is using results for discussions with insurers.

Ohio respondents were most satisfied with the federal Medicare insurance plan for the aged and disabled, even though they have no control over how the government sets rates.

“Whether or not they are happy with the reimbursement schedule, that is a separate issue from whether they have to spend 45 minutes to an hour on the phone,” dealing with a billing question, Costello said.

Private insurers don’t share their rules or they make them hard to find and change them frequently, said Mark Jarvis, the medical association’s senior director of practice economics.

“You learn the rules through denials,” he said.

Administrators had fewer beefs with how much control they have over rates or how fast they’re paid than they did with obscure payment policies.

“I know from our practice … the effort that we put forth to meet the requirements set forth by the payers to properly bill and collect on our patients is phenomenal, and still we’re not very successful,” Fowler said.

Aetna Inc. had the highest satisfaction scores among the five Ohio private insurers measured. Respondents also rated UnitedHealthcare of Ohio, Cigna Corp. and Humana Inc. The last two are not among the top nine managed-care plans in Central Ohio by members covered, according to Business First research.

Aetna said in a statement that it has made “tremendous progress” in simplifying transactions and making rules clear to doctors and other providers.

The September survey came just three months after a new state law took effect aiming to clear some of the confusion. The law requires a common system for insurers to verify a doctor’s credentials, instead of multiple forms, as well as plain summaries of contract terms and an updated source of rate information.

Ashley pointed out efforts at communication and clarity on Anthem’s Web site, although directed more at consumers, include tools that allow patients to compare costs for common procedures at different facilities and rate their experiences with doctors. Physicians also can voluntarily participate in incentive programs for meeting certain goals.

Insurers have worked hard to follow the new law, Costello said.

“There will be some improvement (from the law) but this is a very complex, very deep issue,” Fowler said.

614-220-5458 | cghose@bizjournals.com

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