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Report Cards for Everyone

Elyas Bakhtiari, for HealthLeaders Media, June 19, 2008

The trend these days in health plans is to put physician performance under a microscope, going so far as to issue publicly-posted report cards that rank physicians relative to their peers.

Well, turnabout is fair play.

At its annual House of Delegates meeting this week the American Medical Association announced the release of its first health insurer report card, which is supposed to provide information about the "timeliness, transparency and accuracy of claims processing by health insurance companies."

Is this a jab at payer-issued report cards? No, says William A. Dolan, MD, an AMA board member. But it does reflect the poor state of physician-payer relations today and is the result of physician frustration (to put it mildly) with the bureaucracy and inefficiencies of managed care.

"What we'd like to do is bring transparency and accountability to these insurers," he says.

The AMA argues that the billing process eats up about 14% of physicians' annual revenue, and the report cards, which are part of a larger "Cure for Claims" campaign, aim to cut that number down.

"I use the analogy of an ATM," Dolan says. "What if you went to the ATM and 67%-82% of the time you would not get the amount of money you wanted to withdraw? Or, 3%-12% of the time, you wouldn't get anything."

The report card rates insurers on payment adherence, timeliness, denials, transparency, and compliance with pricing rules, but the overall campaign also recognizes physicians' role in the process and offers tips and education for improving claims processing and coding.

Will the pressure on insurers be effective in reducing the estimated $210 billion in billing-related annual healthcare costs? Not by itself.

A spokeswoman for America's Health Insurance Plans has already shifted the blame by arguing that it takes two parties—both insurers and doctors—to improve claims processing.

But the report card is just "one form of fighting back," Dolan says. Other arrows in the physician's quiver include more aggressive tactics such as class-action lawsuits.

If I were a major health insurer, I wouldn't be worried about the report card so much as the physician discontent—and growing willingness to "fight back"—that it represents.

Other issues that came out of this week's AMA house of delegates meeting to keep an eye on:

Guidelines on medical tourism. This is a first for the AMA, and the principles address "financial incentives, insurance coverage for care abroad, and care coordination." It sounds like the AMA has developed an acute awareness of medical travel.

Report on RUC recommendations. According to Dolan, the Relative Value Update Committee recommended ways to improve the valuation of primary care services, with no opposition from specialists.

Recommendations on "mystery shoppers." The AMA ethics council debated the benefits and drawbacks of medical mystery shoppers and issued a report on the matter. Many physicians are opposed to unidentified "fake" patients, but as Marketing Editor Gienna Shaw points out, mystery shoppers can improve quality and customer service.

Resolution against Ricki Lake. Well, not against Ricki Lake personally, but in a statement of opposition to homebirths performed by midwives (without doctor supervision) the AMA did mention Lake's public support for at-home deliveries. In another turf-defending resolution, the AMA sought to define who could rightfully use the terms "doctor" and "resident."


Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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