A group of docs in Texas has decided that two can play the ratings game. They are working on a project to rate insurers – on their “billing procedures and issues”.
It strikes me that these physicians may be engaging in the same type of behavior that infuriates them when exhibited by insurers – using an arbitrary, internally-developed methodology to evaluate payers solely on administrative indicators.
Yet the docs seem to be blind to the irony.
If physicians are serious about working with payers, it is certainly fair to call them out when appropriate. But if they base their ‘ratings’ solely on billing issues, they may find the mirror provides an unflattering image. Billing practices have rapidly evolved into ‘revenue maximization’, and payers have ample evidence of unbundling, upcoding, and outright fraudulent billing practices on the part of many providers.
Yes, some payers do go too far in their effort to down-code and bundle charges. This is a constant back-and-forth battle, with providers seeking to increase billing and payers working to contain costs. If providers want to contribute to solutions, they should start by not tarring themselves with the same brush they use on payers.
Thanks to FierceHealthcare for the original story.
The providers have chosen to participate with the insurers. If they want to make an impact then terminate their relationship. If enough do, the reduced access in geographic areas will have a financial impact to the insurers.
The physicians have valid concern related to problems with their payers. However, your issue of revenue maximization is a much more important issue. Today’s clinical pathways are influenced by spreadsheets and revenue. Reimbursement is extremely prejudiced in favor of overpaid specialists. There needs to be a paradigm shift toward primary care physicians. Fraud, abuse and over-utilization are rampant and self-referral is slowly becoming the rule for physicians and hospitals. The biggest loser is the American health care consumer.
Joe, sometimes I disagree with you, as I’m generally addressing the provider side of things in FierceHealthcare (and that has influenced my perspective). However, you’re not without a point here. In any event, generally speaking, a tug of war seldom benefits either party. Here’s hoping that insurers and physicians in Texas (and elsewhere) find a compromise.
Providers better be careful. Unless they are squeaky clean in regard to upcoding, unbundling and appropriate utilization and they list some arbitrary report cards the insurers might not just take it sitting down. Seems to me the insurers probably have more sophisticated ways to analyze the data and the health care providers might just find themselves graded on the carrier websites. Just a thought.