In a move designed to improve relations with its physicians, Cigna HealthCare of North Carolina will increase some physician fees to its network of 10,000 physicians.
But it likely won't be the panacea the health plan hopes.
The increase, averaging 8%, took effect Oct. 1. Cigna has no plans to make the increase nationwide.
"It's a very smart move to test out higher reimbursement strategies," says Peter Boland, president of Boland Healthcare, a Berkeley, Calif.-based management consulting company. He says he'll be watching to see whether the increase improves "the relationship between the physician and the health plan. And second, does it enable (the) physician's office to increase the level of care and the breadth of services they're able to offer?"
The move comes a little more than a year after Cigna decided to drop state employees from its plans and months after the company began requiring physicians to get preapproval for MRIs and CT scans. The latter move rankled physicians around the state.
The company recently announced that it might issue "gold cards" to doctors who routinely meet clinical guidelines established by the insurer for medical tests.
A gold card would exempt physicians from having to get approval for those diagnostic tests.
Cigna officials say the reimbursement increase has nothing to do with those changes.
The company achieved its goals of profit and ensuring a high level of care to members and wants to maintain a "satisfied network" of physicians, says Mark Di Giorgio, spokesman for Cigna, which reported $3.77 million in net income for the second quarter.
"Anytime there are changes in procedure or network issues, one of the ramifications is that people tend to experience that as stressful," Di Giorgio says. "Now that we have achieved our goals, we thought it was time to examine the fee schedule to see if it was appropriately priced and to make adjustments to the fee schedule to benefit physicians."
While grateful for any increase in payments, the North Carolina Medical Society believes a number of issues need to be addressed, including preauthorization for diagnostic imaging, says Carol Scheele, director of managed care for the society. The increases will affect office visits only, not procedures that have seen cuts in recent years, Scheele says.
What remains to be seen is whether more power is put back in the hands of physicians, says Allen Hayes, M.D., an internist and pulmonologist with Cardinal Health Care, a multispeciality practice in the Raleigh, N.C., area. "My sense is that it doesn't," he says. "What I think we're really seeing is managed care companies still wish to manage care."