D. Cheryl Erins, director of business operations at the Sinai Medical Group, a Westchester, Ill.-based 200-physician practice affiliated with 291-bed Mount Sinai Hospital, Chicago, says that about one-fifth of the claims her office files get denied initially because of incorrect insurance information. She says that the use of electronic ID cards would also help with the collection of copayments and deductibles and eliminate the need to have to wait two months for resolution and payment of disputed claims.
I could probably take five FTEs away easily, says Erins, a board member of the American College of Medical Practice Executives, the MGMAs certification and standard-setting body.
Joseph Mondy, assistant vice president of information technology communications at insurer Cigna, says he doesnt expect his company to use the cards.
We took a look at them and, frankly, the negatives outweighed the positives, Mondy says, explaining that doctors are reluctant to invest in the technology and dont have much reason to do so. They have access to more information simply by going on our portal.
Jessee says an aim of the campaign, which is an offshoot of the MGMAs longstanding administrative simplification advocacy efforts, is to achieve critical mass where enough payers are using the technology to make it worthwhile for physicians to use it as well.
If you achieve that, it will create market pressure on the others to move in this direction, Jessee says. Previous efforts to implement card-swipe technology failed, Jessee explains, because not enough payers were offering it and practices were reluctant to have a separate system for just one planand this led the pioneering companies to discontinue using the technology and view the whole effort as a failed experiment.
A change in philosophy is another reason why machine-readable ID cards may soon reach widespread useand multiple applications as well.
A few years ago, Willman says, many stakeholders were talking about using smart cards where a patients records were stored on a chip, but that required medical providers to have the technology on hand to access the chip and update that stand-alone file.
Instead, the cards the MGMA is now promoting, which are used in the Florida pilot, contain only the most basic information and function as a key to enter a Web-based portalknown as Availitywhere patient information is kept. From there, Willman says, providers should be able to have real-time claim adjudication and review a claim-based electronic health record.
The three payers in the Florida pilot agreed to technological specifications set by the American National Standards Institute, which were updated and formulated into an implementation guide published by the federal Workgroup for Electronic Data Interchange, or WEDI, in November 2007.
Also in 2007, Texas passed legislation promoting electronic insurance ID cards; Colorado and Ohio did the same last year. Jessee says that he appreciates these efforts, particularly in his home state of Colorado where he said the Legislature lit a fire under the plans. But he also fears that individual state efforts could lead to 50 sets of standards, so the MGMA is calling for stakeholders to follow the WEDI playbook.
In that respect, he said he liked what is happening in Texas where plans for a legislatively mandated pilot were scrapped out of concern that it would interfere with the pilot already launched by the Blues, Humana and UnitedHealthcare where the same formula that had been used successfully in Florida was being repeated.
I would tend to agree with the Texas approach because the ideal way for this to happen is by a voluntary private-sector initiative, Jessee says, adding that legislative action was necessary in Colorado because there was no voluntary private-sector initiative happening.
Texas Insurance Department spokesman John Greeley says that the state realized its efforts were being eclipsed by the private companies that had more resources and already had the technology in place to get the pilot off the ground.
They pretty much overtook us, Greeley says. The carriers themselves were doing better than we could.
Representatives from UnitedHealthcare or Blue Cross and Blue Shield of Texas could not be reached for comment.
Ben Price, executive director of the Colorado Association of Health Plans, says it appears that the state will be following the WEDI guide.
Our position is that if standards are going to be put in place (in Colorado), they should be national standards that apply to everyone, Price says. We were happy to see this discussed at the last work-group meeting.
Price describes the MGMAs Jan. 1, 2010, target date for stakeholder commitments as an ambitious undertaking, but added that Were in a positive position in Colorado because we have a statute in place and motion from the plans themselves at the same time.
In addition to how long it will take Medicare and Medicaid to institute electronic ID cards, the other big question is whether users will prefer swipe cards with a magnetic stripe or cards with bar codes.
The MGMA and WEDI are counting on market pressure to make that decision. Jessee says that it wouldnt be difficult to start off with a belt and suspenders approach and put both on the ID cards.
Computer design consultant Peter Barry, co-chairman of the WEDI panel that developed the implementation guide, compares it to consumers choosing VHS over Betamax videocassette players, and says health plans like magnetic stripes while the pharmaceutical industry prefers bar codes.
Barry agrees with Willman in that he predicted success for the MGMA campaign, but thatno matter how compelling the arguments to get it done swiftlyimplementation will take time.
We always overestimate what will happen in one year, but underestimate what will happen in five, Barry says. I think the marketbecause of the benefitswill adopt this voluntarily, and well be surprised how completely it will in five years.