Payer Rankings Don't Tell Providers' Stories

When MGMA-ACMPE (formerly Management Group Medical Association) released its annual ranking of payers in mid-November, the list of who is doing the best job keeping practice professionals satisfied looked exactly the same as last year. Medicare Part B topped the list and United came in at last place.

But a closer look at the satisfaction scores MGMA-ACMPE members assigned to payers reveals practice professionals aren't as happy as the list indicates at first glance.

For the last five years MGMA-ACMPE has conducted a poll to determine group practice professionals' attitudes toward payer interactions. This year, the 13-question survey focused on seven categories:

1. Overall satisfaction
2. Payer communications
3. Provider credentialing
4. Contracting
5. Payment policies
6. System transparency
7. Innovative payment models

In nearly every category, Medicare Part B and Cigna were in one of the top three positions. Stephen Mandolesi, chair of MGMA-ACMPE's Payer Contracting Society and Director of Network Management for Lifeline Vascular Access in the east, called Medicare Part B's consistency "amazing."

"About 15 years ago Medicare Part B was the worst payer," says Mandolesi. "Now what you find is a lot of practices tend to compare the contractual allowable that a health plan is going to pay them based upon what Medicare is reimbursing, so Medicare has become the benchmark for reimbursement."

Mandolesi also says in some ways, practices find dealing with Medicare Part B easier simply because the federal agency has made everything available online, including fee schedules. In fact, Medicare Part B received the highest score of the entire poll on the question of willingness to disclose fee schedules. MGMA-ACMPE members gave the agency a score of 4.18 out of 5.

With Medicare Part B dominating nearly every category, it was surprising to see that their overall satisfaction score was 3.53, based on a scale of 1–5, putting it halfway between neutral and moderately satisfied. That's not exactly the same as practice professionals saying " 'Great job!' "

Mandolesi attributes the midrange score to the fact that Part B claims are processed by federal contractors. "There's probably still issues out there with the way those contractors process the claims, one; with the policies they have in place, two, and with the RAC [recovery audit contractors] audits."

Low rankings don't equal low scores
If payers who ranked high in MGMA-ACMPE's poll received a midrange score, then payers ranking low must have done terribly, right? Not really, though it is a logical conclusion.

Consider the ranking of United Healthcare on the same metric on which Medicare Part B ranked first—overall satisfaction. United was last on the list with MGMA-ACMPE members assigning it an average score of 2.77 on the 1-5 scale, putting it between "moderately dissatisfied" and "neutral."

The score indicates providers may be more apathetic than dissatisfied with payers, though it's not to say there aren't specific complaints.

Don Stumpp, an MGMA-ACMPE member and manager of payer contracting for American Health Network, a group of 200 primary care and multi-specialty physicians, says communication is a big problem.

"Payers rely on communicating through their websites, but practices do not have the time to search websites for answers," says Stumpp. "Unfortunately many payers have cut back on staffing for provider representatives who can come to your practice and help you navigate through issues. They want us [providers] to use their toll-free number that frequently does not resolve the issue.  They need to bring back the reps."

Stumpp was also quick to say that providers are improving, specifically United.

"My personal experience with United Healthcare has been they now have dedicated provider advocates and town hall meetings. I think it has helped, but unfortunately the national survey did not reflect that."

Cigna has also focused on improving the experience for healthcare providers, says Julie Vayer, Cigna's chief operating officer for its Total Health & Network organization. "We decided we would spend a lot of time soliciting feedback from the healthcare community. We literally conducted between 100-200 interviews with professionals in our network," says Vayer. 

The surveys Cigna collects show similar metrics as MGMA-ACMPE's. "There's no gap," says Vayer. "We discovered they [providers] really wanted to be paid quickly... transparent communication, and more information."

She says Cigna's customer service representatives receive more and specific training than they did just two years ago to meet the needs of providers. The website modifications are also aimed directly at healthcare professionals.

"We've redesigned our website to make it easier. [It] takes fewer steps to find what they're looking for. We heard from the physician community that our website is much improved," says Vayer.

What may be contributing to the mediocre scores isn't so much the antagonistic relationship between providers and payers, but the complicated nature of healthcare today. Vayer concedes "healthcare professionals are asked to do a lot of things," and believes that may be why payers are not receiving high scores.

Mandolesi goes further, saying with so many different coverage decisions and policy guidelines, providers can't help but be confused and frustrated.

"It's an interesting dynamic we live in right now in healthcare," says Mandolesi. "There [are] so many moving pieces and parts and I think the problem is that physicians just want to be able to provide services, and that when a patient walks in with an ID card they're covered under that policy, and they'll get reimbursed and everyone's happy."

For now, it seems the conclusion on both sides is to meet in the middle, which is where most of the satisfactions scores are, too.