Perspective survey finds practice-payer relationships still lacking transparency


Some relationships are more laborious than others. They require time spent navigating the tangles of disagreement and the more deceptive coils of one-upmanship and greed. And to the victor goes the spoils.

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It is in this context that the very long engagement between payers and providers in the healthcare sphere has been unfolding — where physicians and practice managers strain to see eye to eye with their payer partners, who in turn, struggle to hear out their other halves. Furthermore, according to the latest MGMA-ACMPE perspective survey, these days of tough love are far from over.

The input of nearly 800 MGMA-ACMPE practice manager members characterized overall satisfaction with payers as primarily dependent upon the accuracy, consistency and timeliness with which payers responded to questions. The fifth installment of the survey, this year’s questionnaire measured once more member consummation with mega national health plans — a prestigious group inclusive of Aetna, Anthem, Cigna, Coventry, Humana, Medicare Part B and United Healthcare. Payer communications, provider credentialing, contracting, payment policies, rating system transparency, overall satisfaction and payer willingness to engage in innovative payment models were all topics up for membership judgment. [Refer to Figure 1 and 2 below for overall satisfaction results and satisfaction with question response.]

Figure 1:

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Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

All information, titles and data from the MGMA-ACMPE “Practice Perspectives on Payer Performance, 2012” survey. Presentation by PhysBizTech.

Figure 2:

Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

All information, titles and data from the MGMA-ACMPE “Practice Perspectives on Payer Performance, 2012” survey. Presentation by PhysBizTech.

The predominantly average to below average ratings have become indicative of a persisting transparency problem between payer and provider parties.

“Transparency is a huge issue,” Allison Brennan, a senior advocacy advisor for MGMA-ACMPE, told PhysBizTech. “Historically there have been a lot of issues with a lack of transparency when dealing with insurers, and this can range from everything regarding their fee schedules to various aspects of the contractual relationship, to changes in payment policy or how they navigate complex prior authorization processes, or dealing with claims that are denied or have to be resubmitted.”

“In certain areas we’re seeing increased transparency across the board with payers,” Brennan added. “One of the questions regarding the disclosure of fee schedules is something that has actually scored higher in recent years, so we have seen improvement in that area.” [Refer to Figure 3 below for question results.]

Figure 3:

Based upon a 5 point scale where 1=No transparency, 2=Slight transparency, 3=Moderate transparency, 4=Considerable transparency, and 5=Complete transparency.

All information, titles and data from the MGMA-ACMPE “Practice Perspectives on Payer Performance, 2012” survey. Presentation by PhysBizTech.

Regarding the most surprising results, Brennan referred to newly included questions with respect to how providers quantify payer consideration for innovative payment models.

“One of the things that was a little surprising, and this is partly because it’s the first year we asked these questions, but the responses to the questions about innovative payment models — how willing the payer is to engage in innovative payment models. And across the board, the answer that we received from our members is that they did not feel that a lot of payers were willing to enter into these models. So those numbers were a little lower than we expected. That being said, I know that payers are doing a lot different things, so if you’re in a particular practice you may not be aware of certain opportunities that payers may have because they may not pertain to your practice.” [Refer to Figure 4 below for this question’s results.]

Figure 4:

Based upon a 5 point scale where 1=Completely unwilling, 2=Moderately willing, 3=Neutral, 4=Moderately willing, and 5=Completely willing.

All information, titles and data from the MGMA-ACMPE “Practice Perspectives on Payer Performance, 2012” survey. Presentation by PhysBizTech.

MGMA-ACMPE affiliates strongly caution providers to make decisions about subscribing to innovative models and contracts wisely by allocating enough time for proper research/dialogue.

“One thing that we have emphasized with innovative payment models and entering into new innovative contracts of pay-for-performance programs, is that we want to make sure that our members are fully prepared and thoughtfully entering into these new models,” Brennan said. “We don’t want to see practices rush into new models even though we’re hearing a lot of buzz words and we all see that the industry is shifting toward some of these things — we just want our members to make sure that they’re making the right decision for their practice before entering into any of these models.”

Additionally, practices can determine if the model being proposed by a payer will fit their agenda by “having complete control of their data and really understand[ing] their costs and what risk may be associated with these types of models,” Brennan noted.

Medicare Part B held the top seed in many categories including overall performance, responsiveness to questions, willingness to disclose fee schedules and payment policies, and claims-appeals process. It finished last in the provider credentialing category. As such, the MGMA Government Affairs staff continues to work closely with the Centers for Medicare & Medicaid Services (CMS) to streamline and improve the Medicare enrollment process.

“I actually participate on a quarterly workgroup with CMS and a handful of providers that focuses on the enrollment process,” Brennan said. “I was hoping to see an improvement in the scores for credentialing with Medicare because they have really taken a number of positive steps over the past two years to reach out to the provider community, to talk with us about the potential changes they’re thinking about making to the PECOS system and to get our feedback.”

The MGMA-ACMPE recommends that Medicare standardize its provider credentialing with other public and private payers though adoption of the Council for Affordable Quality Healthcare Universal Provider Datasource, to aid in this effort.

While there’s still a long way to go to a more effective union, both Brennan and other MGMA-ACMPE officials feel the survey provides valuable feedback for payers to consider when taking the next step with practice relations.

“We like to use this as an opportunity to have an ongoing dialogue with the payers and talk about ways that we can work together better because at the end of the day, right now in the healthcare industry, there’s so much pressure to control costs and everybody wants to provide access so that we can truly be delivering the best quality patient care that we can best provide in the industry. To achieve some of those higher-level goals, having payers and providers work together in a positive way really is essential,” Brennan concluded.

“It’s mutually beneficial to keep lines of communication open, and for our members and the payer community to cultivate deeper relationships. Ultimately, these interactions may result in less distraction and resource diversion from practices’ primary focus, the needs of their patients,” Susan Turney, MD, MS, FACP, FACMPE, MGMA-ACMPE president and CEO, declared along similar lines in a news release.

Find the survey in its entirety here. [See also: MGMA urges HHS to take immediate action on 5010-related payment delays]

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