MGMA-ACMPE hopes survey data ultimately reduces distractions and resource diversion for physicians—including pathologists—that result from interactions with payers
When physicians and their practice managers are surveyed about their satisfaction with health insurers, the Medicare program outscores all private health insurers. This was just one finding of an annual survey on this topic conducted by Medical Group Management Association-American College of Medical Practice Executives (MGMA-ACMPE).
Certainly pathologists have their opinion about the service levels of different health insurers. However, MGMA’s survey does not break out physician satisfaction by different medical specialties. The survey findings reveal that most physicians are neutral or dissatisfied to some degree when queried about different aspects of service provided by Medicare and private health insurers.
In its 2012 survey on payer performance, MGMA members were surveyed on their satisfaction with major national health plans.
Health insurers mentioned in the survey were:
• Aetna (NYSE:AET)
• Anthem (NYSE:ATH)
• Cigna (NYSE:CI)
• Coventry (NYSE:CVH)
• Humana (NYSE:HUM)
• Medicare Part B
• United Healthcare (NYSE:UNH).
“Our members work with payers on a daily basis, and identifying areas of improvement is paramount,” stated Susan Turney, M.D., MS., MGMA-ACMPE President and CEO. She was quoted in an MGMA-ACMPE press release on results of the survey.
“It’s mutually beneficial to keep lines of communication open, and for our members and the payer community to cultivate deeper relationships,” continued Turney. “Ultimately, these interactions may result in less distraction and resource diversion from practices’ primary focus, the needs of their patients.”
If there is a core observation from the overall survey results, it is that no payer earned a rating higher than 3 on any of the key areas. Three represents a “neutral” score—neither satisfied nor dissatisfied. Most pathologists and clinical laboratory executives would not disagree with the overall survey results.
Medicare Part B Consistently Receives Higher—but Still Not “Satisfactory”—Ratings
In the area of “overall satisfaction,” Medicare Part B, CIGNA, Aetna, and Coventry ranked in the “neutral” category. Practice executives expressed that they were “moderately dissatisfied” with Anthem, Humana and United Healthcare.
According to the MGMA-ACMPE press release, the key drivers of overall satisfaction with payer performance include:
1) accuracy and consistency of payers’ responses to questions;
2) time it takes payers to respond to questions;
3) the promptness of claims payment; and,
4) the claim appeals process.
A strong correlation between members’ overall satisfaction with payers and the accuracy and consistency of payers’ responses to questions was noted by surveyers.
(MGMA-ACMPE Survey Results)
What is your overall current satisfaction with the payer?
Ranking – Payer – Rating Average
1. Medicare Part B, 3.53
2. CIGNA, 3.20
3. Aetna, 3.16
4. Coventry, 3.00
5. Anthem, 2.99
6. Humana, 2.83
7. United Healthcare, 2.77
Based upon a 5 point scale where 1= Completely dissatisfied, 2 = Moderately dissatisfied, 3 = Neutral, 4 = Moderately satisfied, and 5 = Completely satisfied.
The area that reflected the least dissatisfaction was payer willingness to disclose the fee schedule used to reimburse a practice under the terms of its contract. No respondents expressed “dissatisfaction.” However, the highest score—Medicare Part B with 4.18—merely indicated practice executives found it “moderately willing” to disclose. The remaining payers only received a rating of between 3 and 4, or “neutral.”
Based on the survey results, another area that could use some work is rating system transparency. That is, the cost and quality measures used by the payer for its physician rating and/or pay-for-performance programs.
Although Medicare Part B’s transparency score of 2.73 stood ahead of the pack, it still fell in the realm of only “slight transparency.” The remaining payers barely scored above 2, with 1 indicating “no transparency.”
Survey Shows Payers “Unwilling” to Use Innovative Payment Models
In this area, no payer achieved a score of even “moderately willing.” They were all ranked in the “completely unwilling” category. Scores ranged from lowest for Coventry at 1.66, to highest for Medicare Part B at 1.95.
“We welcome opportunities to engage with payers on new payment models and understand that the industry is still developing these options,” observed Turney in the release. “It’s important for our members not to rush into new models if they aren’t beneficial for their patients and practices. Aligning the incentives for practices, patients and payers will be key for these types of arrangements to be successful moving forward.”
For pathologists and clinical laboratory managers, the wide variation in performance and overall dissatisfaction with payer performance signals continued opportunities for savvy laboratories to find ways to add value to office-based physicians, as they grapple with the changing reimbursement landscape.
—Pamela Scherer McLeod