It feels good to level the playing field.
Payers rank physicians on everything from E&M coding patterns to quality of care. They have reams of data at their disposal. But physicians are at a loss when it comes to assessing payers.
There has never been a way for physicians to gauge the performance of payers in meaningful terms. “There is not a lot of infrastructure in place to allow physicians to be more than price-takers,” says Kim LaFontana, vice president of payer performance management for athenahealth, a company that handles billing processes for thousands of physicians around the country.
That’s why Physicians Practice and athenahealth got together to bring you a first-of-its-kind index to rank payers, nationally and regionally, on how well they work with physicians.
The index, called PayerView, uses athenahealth’s aggregate data on thousands of billing transactions as the basis for ranking payers on how efficiently they reimburse physicians for their services.
Why did we bother? Because it’s high time physicians like you have a mechanism for sorting the best payers from the worst. You already know (or should know) how much your payers are paying you. And if you’ve been reading our annual Fee Schedule Survey, then you have a pretty good idea of how your allowables stack up against those of other practices in your region.
But understanding how well you’re being treated by insurers requires more than a quick glance at a fee schedule. What’s missing is a tool for measuring the dreaded “hassle factor” when it comes to dealing with payers.
How often does Payer A deny claims? How much time does your staff have to spend on the phone with Payer B sorting out problems? Does Payer C make a habit of “slow-paying” you? The answers to questions like these can help you decide whether to keep or drop a contract.
But only when you can interpret the answers. It’s not enough to have, as most practices do, a sense of which payers are the most troublesome based on staff complaints and hallway anecdotes. Suppose Payer A rarely denies a claim and is always responsive over the phone, but your staff tells you that its checks tend to come in later than anyone else’s. What if Payer B denies claims routinely but almost always backs down on appeal? Which one is better? Is either worth the trouble?
To make such judgments, you need a tool for analyzing patterns of payer behavior and enough data to make your analysis fair and useful.
That’s where PayerView comes in. We ranked payers using hard data gleaned from athenahealth’s rich database, weighting specific data points differently based on what’s most important to practices. (For detailed information on the measures we chose to evaluate payers, see “Here’s What We Measured and Why.”)
The idea is to arm you with information about payer performance so you can make good business decisions about payer contracts. In turn, we’re also letting payers know how well they are treating providers relative to their competition. It’s a call for better cooperation.
About our methods
All PayerView data come from athenahealth, a service and software provider and the country’s largest revenue cycle management company for office-based physician practices. Because it handles millions of claims on behalf of practices across the country, its database is a treasure trove of information about how those claims were processed. With help from athenahealth’s number-crunchers, we were able to develop a profile of payer behavior from around the country — simply by examining their own claims processing histories.
How? We identified seven key measures to assess payers, and gave each one a weight based on its importance to physician financial well-being. Then, athenahealth queried its claims database to produce the results you’ll find here. (See “How We Ranked the Payers” for details on our “weighting” methodology.)
