In the name of saving time and trees, more state medical societies are working with HMOs and PPOs to develop one standard application for physicians joining provider networks instead of forms unique to each insurer.
"There were a lot of organizations asking similar questions," said Paul Mahoney, executive director of the North Carolina HMO Association. "Our aim was to get a more common platform. Physician management organizations are very happy to see this because it saves them a lot of time."
The effort to develop a standard application has been well-received by many small insurers. The next step is figuring out how to get large insurers to accept it, and state medical societies are trying everything from asking nicely to lobbying for legislation to get that accomplished.
State medical societies and insurers in North Carolina, Pennsylvania and Washington this year have joined California, Massachusetts, New York and Ohio in introducing a standard provider network application. Oregon is expected to debut its form this summer.
In Pennsylvania, the state's medical society negotiated with 26 HMOs and PPOs to develop a 10-page, 150-question form that has been in use since January. While that's still an extensive document, it's a big improvement from the original 464 questions the insurers proposed, said Pennsylvania Medical Society spokeswoman Amy Dugan.
Pennsylvania's physicians and practice administrators are so happy with the single form, society representatives have gotten "standing ovations" at conferences, Dugan said.
But please, hold your applause. Even those states with single applications have a long way to go before physicians have to stop shoveling out a blizzard of paperwork to be part of more than one provider network.
Most of the insurers accepting Pennsylvania's standard application are relatively small local groups, while Blue Bell, Pa.-based U.S. Healthcare, which has the largest share of Philadelphia's HMO business, has refused to accept it.
After receiving a tepid response to its form, the Ohio State Medical Association--along with Kaiser Permanente Health Plans--lobbied successfully to include a measure forcing insurers to accept standard applications as part of a pending managed-care bill. "As long as it's voluntary, it won't be widely accepted," said Carol Mullinax, spokeswoman for the Ohio State Medical Association.
However, a standard application can be created and accepted without legislation if different organizations truly cooperate, said Jill Douglas, director of development at the California Medical Association. Thirteen health plans, including major insurers such as the California Blue Cross and Blue Shield plans and Cypress, Calif.-based PacifiCare Health Systems, are accepting the form, which was developed by hospital, physician and insurance organizations.
California, unlike other states, included hospitals and independent practice associations in developing a standard application. In many states, insurers or medical societies have developed their own form and asked others to accept it.
Inspired by the states, organizations such as the American Group Practice Association, the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance began meeting in March to develop standard elements for provider network application forms.
The groups do not expect to create a single national form, said Dirk Thornley, AMGA vice president of managed-care services. However, states could use the organizations' suggestions to come up with their application, he said.