In the first physician-satisfaction survey on insurers made public, the Harris County (Texas) Medical Society recently gave poor marks to six Houston-area health insurers, saying the companies have failed patients, employers and doctors on patient-care, payment and customer service issues.
I was surprised how bad it is. All insurers were rated very low by doctors in most areas, and the response was quite uniform, said Kimberly Monday, M.D., a neurologist and vice-chairwoman of the societys board of medical legislation. The survey shows insurance companies are failing patients, doctors and employers who pay for healthcare services by creating ways and resistance to hold onto their money.
The release of the survey was just one of a number of efforts by physicians to turn up the heat on health insurers, which organized medicine claims are putting profits ahead of patient care. Earlier this month, for example, New York Attorney General Andrew Cuomo announced plans to file a lawsuit against UnitedHealth Group, the nations largest health insurer, for allegedly gerrymandering reimbursement rates paid to physicians and other healthcare providers (Feb. 18, p. 12).
Here are some highlights of the survey:
Several health plans, including Blue Cross and Blue Shield of Texas, have contacted the medical society about improving physician satisfaction and patient care.
(We) care a great deal about service, said Margaret Jarvis, a Texas Blues spokeswoman, in a statement to Modern Healthcare. In fact, we usually fare a lot better than our competitors in these kinds of surveys. Although we had no advance notice of the survey, Blue Cross is very aware of physician dissatisfaction on the issues raised in the survey.
Some 487 physicians responded to the survey, which evaluated Aetna, Cigna Corp., Humana, the Texas Blues, UniCare and UnitedHealthcare.
We had a doctor talk about macular degeneration turning into lost eyesight because the patient could not get treatment approved, Monday said. Another patient died while waiting for his insurer to preauthorize a magnetic resonance angiography, a test that could have revealed the carotid artery dissection that triggered his stroke, she said.
Doctors complained about a range of issuesdelayed reimbursements, paying less than contracted rates, providing services without reimbursement, and time spent trying to preauthorize medical services.
We have to hire one additional staff member per doctor just to handle insurance, Monday said. Some 83% of doctors say they have hired additional staff.
Insurers want to know why we are approving medical services or prescriptions and want us to provide three peer-reviewed articles to prove what we want to do, Monday said.
She said doctors waste too much time having to talk with nonmedical insurance personnel before speaking with nurses or medical directors.
I dont mind talking with a nurse, but the next step I expect is to talk with a doctor, Monday said. They put up barriers so that it takes days or a week to do that. Is it necessary for me to spend an hour trying to convince an insurance company of a procedure that is an accepted standard of care?
William Jessee, M.D., president and chief executive officer of the Medical Group Management Association, Englewood, Colo., said he supports the idea of physicians rating insurance companies.
While the Harris County group is the first medical society to make its survey public, the Colorado Medical Society conducts similar surveys of insurers, Jessee said. They use the data to talk with insurers privately to make changes, he said. They feel it is a pretty effective mechanism. But Jessee added, Making it public is a new twist. The climate in Colorado is different than in Texas.
Monday said the association may conduct the survey every other year. It would be interesting to see if there are regional differences, she said.
But could the Houston survey backfire on doctors?
It could be useful but it depends on whether this is a rifle with one bullet fired or part of a strategy to bring pressure on insurers, Jessee said. I am always frustrated that physician organizations are not doing enough to engage business in trying to bring pressure on the insurance industry.