Managed Care Contracting & Provider Payment

Quick Post: AMA Announces Insurer Rating, AHIP Responds

Yesterday, the Chicago Tribune ran a story describing the AMA's new insurer report card aimed at "hold[ing] health insurance companies accountable for making claims processing more cost effective and transparent and to educate and empower physicians so they are no longer at the mercy of a chaotic payment system that takes countless hours away from patient care."

Link to Chicago Tribune Article: Here
Link to AMA "Cure for Claims" press release: Here

The American Association of Health Insurance Plans has issued a statement noting the improvements in claim payments brought on by electronic claim processing.

AHIP Statement: Here

Price Estimates and Informed Consumers

I received a call from a hospital describing an increasingly common scenario:  a potential patient calls asking for the price of an outpatient CT scan; either because he is uninsured or is covered by insurance with a deductible.  The caller had already called several other providers and this hospital’s price was higher.  Even if the caller was covered by a high deductible plan (and was therefore entitled to pay the insurer’s negotiated rate) the hospital’s charge for the scan was still higher than the competitors’ prices – especially outpatient scanning sites.

The hospital wanted to know whether it could match their “competitor’s” price for the MRI.

Resource on Transparency Initiatives

I discovered a web site dealing with transparency initiatives - whether by health plans, states or Medicare.  It is "AboutHealthTransparency".  It appears quite comprehensive and is well organized (where do they find the time?!)  If you're interested in tracking a specific effort at tiering or ratings, it is worth checking out.  Happy researching!

Another (Questionable) Approach to Transparency

I sometimes participate on a list serve of attorneys who work in managed care - whether from the provider or payor “side of the table”. An attorney representing a group of specialty physicians recently posted asking how he could get information about the rates insurers paid to other area physicians practicing in the same specialty. His suspicion was that his client's insurance contracts were outdated and their payment rates were significantly below the market.

Patient's Charter – A Push for Greater Transparency and Consistency in Physician Evaluations

On April 1^st, a consortium of physician organizations, quality advocates and health plans announced that they had agreed on a set of principles for health plans to adopt to their programs to evaluate and rate physicians. The purpose of the principles was to recognize the need for consistency and standardization in measures.

6 Health Plans Agree to Adopt Physician Ranking Code Promoted by NY Attorney General.

Several state and national insurers have agreed to follow a code for their physician quality ranking efforts. The code is contained in “first in the nation” legislation supported by the NY Attorney General and is announced as a major attempt to coordinate the insurer’s various health care quality transparency initiatives and to provide transparency for the ranking process.

Effect of Minnesota Law Limiting Drug Company Gifts Studied

In yet another update to posts about laws limiting drug company access to information about physician prescribing practices, here is a link to a New York Times article describing the effects a 2 year old Minnesota law had on pharmaceutical marketing. The law barred drug companies from giving physicians gifts (including food) of more than $50 per year. Since then, the article reports, Minnesota primary care physicians have declined to see drug reps at twice the national average rate.

A link to the article is: Here

Link to Original Post: Here
Link to 1^st Update: Here
Link to 2^nd Update: Here

Battle Over Commercial Use of Prescribing Information Moves to Maine & Vermont

This is a quick update on the issue of whether drug representatives can have access to physician's prescribing data.

Last January 30^th, I posted on a pending lawsuit challenging New Hampshire's law limiting access to information on physician drug prescribing habits. Link to original Post In May, I updated you on the decision striking New Hampshire’s law as an overbroad restriction on speech. Link to 1^st Update.

NY AG Targets Aetna & CIGNA Rankings, too

As a further note to Wednesday's post about the NY AG letter to United HealthCare, here is a link to a LA Times article noting that the NY AG also takes a dim view of the physician rankings used by Aetna and CIGNA.
Link to: LA Times Article

Doctors Bring Class Action to Stop Ranking System

Following the theme of yesterday's post about the New York AG's attempts to block the launch of UnitedHealth's Premium Program, Tuesday's Hartford Courant ran an article about a class action filed in July by the Fairfield County Medical Association against CIGNA and United HealthCare.