Thick, innocuous appearing mailings from insurance companies often arrive in a physician’s inbox. Most physicians probably toss these directly into the nearest trash receptacle. Who has time with the increasing demands of patient care, meaningful use, and PQRS bearing down upon us? Perhaps we might take a moment to forward them to our administrators responsible for this messy part of healthcare delivery. Rarely would any of us take the time to read the fine print pages buried inside such a mailing. Perhaps, that is why the information in a recent missive from Emblem Health® struck like a thunderbolt!
Under the title “Providing Timely Care to your Patients,” I learned that the combined and mutual efforts of the New York State Department of Health (NYSDOH), the Centers for Medicare & Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) now require surveys by insurance companies to measure our patients’ access to care (the spectrum of routine, urgent, preventative, specialty and 24 hour emergency). The penalty for noncompliance (which implies second survey failure after notification of first failure) is reporting to the Credentialing/Recredentialing Committee and the potential for removal from the insurance panel.
I found myself asking—Does this really help?
Physicians all recognize the need to be available and accessible to our patients. Most of us are also patients and family members of patients with serious conditions, so we fully appreciate the anxiety that accompanies the pain, suffering, and unknowing of many illnesses and delays in obtaining intervention.
Setting suggestions for timeliness seems ok, but this methodology has serious concerns:
- Should compliance be placed in the hands of health insurers? Especially, given their track record of poor responsiveness to physician practices and patients (remember legislation was required to ensure basic things like “right to appeal” for patients).
- Are our healthcare premium dollars spent wisely for this rather than for the direct provision of healthcare?
- Was any consideration given to the fact that most physicians participate in multiple health plans, with the result that each practice (whether a solo practitioner or multi-specialty practice) will be surveyed on this same issue many times with clear squandering of resources?
- Will noncompliance potentially result in a smaller available network (many of which are already highly stressed, especially in the many new insurance exchange products offered); thus resulting in further treatment delays?
As a neurosurgeon, I am constantly aware of the need to provide rapid patient access for a multitude of reasons. Interactions with other neurosurgeons confirm that we all strive to provide the best access of care for our patients, often opening early, staying late or juggling visits between multiple surgeries. If these accommodations are not met, we know that patients, “vote with their feet.” The result? Modifications to office protocols that will ensure greater accessibility. A clear example of how sound business principles and the free-market can and does work to benefit patients in the delivery of healthcare.