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Finance: Examining Payer Performance
In its third year, PayerView is still making a difference.
By Pamela Moore

One of Richmond Bone and Joint Clinic’s most important payers was slashing its rates, and Juliet Breeze wasn’t sure what to do about it. Breeze, the Texas practice’s lone physician, wondered how other area practices were responding to the cuts, but knew she couldn’t just ask them. “There is such a silence about everything. You can’t share what you are getting paid.”

It was just lucky, then, that while Breeze was shopping for health insurance for her own staff, a sales rep for the payer in question happened to mention that beneficiaries could go online to compare the rates physicians get and so, presumably, choose the least expensive ones.

Being no fool, Breeze immediately asked for a demo user name and password.

“Lo and behold, there is a fee schedule for us and all our competitors,” she recalls. “I [felt] like one of those miners that struck gold. I stayed up all night printing out data. I made this whole book presentation from their own Web site on where we stood compared to our competitors and then I went and asked for a raise.” She got her raise (though a smaller one than she’d hoped for).

Payers are happy to rank your performance on cost and quality. But as for you ranking their performance in their dealings with practices? It’s never been possible to do so such a ranking, except subjectively.

Until PayerView came along.

This is the third time that Physicians Practice has teamed with athenahealth for hard data on payers to help you make better contracting decisions.

With PayerView, we’re putting them on notice that physicians are judging their payment performance.

More importantly, when payers are publicly judged on how they treat physicians, they care more about it.

The broader goal: Identify quantitatively where physician-payer relationships are breaking down, measure trends, and work toward improvements.

In this third year of PayerView, it’s clear that payers are starting to respond to public scrutiny of their performance.

Here are all the details.

Instead of reporting on anecdotal opinions about payers, PayerView is based on actual claims data derived from athenahealth’s athenaNet system database. Athenahealth provides physician billing, practice management, and EMR services via application service provider software. That means it can access billing and payment data.

Other organizations that compare payers rely on opinions and subjective surveys; two examples of which are The University of Michigan’s American Customer Satisfaction Index, and the Davies Public Affairs survey of hospital executives.





Additional Resources
View more articles from the June 2008 issue

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In Summary
The third annual PayerView reveals how easy — or hard — it is to work with payers:

  • Aetna, Cigna, and Humana were the top three performers nationally. Champus/TRICARE came in last.

  • Days in A/R increased slightly, on average, for national payers, but decreased for regional payers.

  • NPI hassles are to blame for some poor performance.

  • Electronic tools smoothed physician-payer relations, especially for regional payers.

  • Consumer-directed initiatives are still on the rise, though more slowly than in past years. Practices need to focus more on patient collections.

  •  
    Read More About It
    Want to learn more about payer relationships? Try reading these:

  • Learn how to assess your payer contracts by reading “Operations: Monitor Payer contracts.”

  • Find out if payers are paying you well by reviewing our 2007 Physicians Practice Fee Schedule Survey Results.