Billing survey puts WellPoint in last: Insurer calls 'pain in the butt' index flawed, but some doctors say findings aren't surprising

June 26, 2006

A physician-billing service recently gave WellPoint Inc. a virtual spanking over its sometimesstrained relationship with doctors.

M a s s a c h u s e t t s - b a s e d Athenahealth Inc. rated the Indianapolis insurer last out of seven national payers in its so-called "pain in the butt" index posted online late last month.

The unusual index aims to tell doctors how easy-or difficult-it is to work with each insurer by using data the company gathered while billing for more than 7,000 physicians around the country.

WellPoint representatives dismiss the rankings as a statistically insignificant advertising ploy that measures only a sliver of the insurer's overall business.

Company spokesman Jim Kappel compared the study to trying to evaluate a baseball pitcher based on his performance against one batter.

"And that could be stretching it a little, too," he said. "What Athenahealth has published is purely a marketing tool that's designed to drive up business, and it should not be mistaken as anything else."

Still, some Indianapolis physicians say the study's conclusions reflect dealings they and their colleagues have experienced with the insurer.

If advertising was one of the objectives, Athenahealth certainly met its goal. The New York Times and Los Angeles Times are among the newspapers that have run articles on the survey since its release.

No other index ranks doctor-insurer relationships this way, according to the Chicago-based American Medical Association-which was part of the reason Athenahealth compiled its rankings.

Insurers routinely profile doctors on cost and quality, so Athenahealth decided to reverse roles "to really have true transparency," company spokesman John Hallock said.

The company formed its index and the categories that constitute it based on data collected during last year's fourth quarter.

"We tried to pick the [categories] that really best illustrated the kinds of complexities that providers experience," said Kim LaFontana, Athenahealth's vice president of performance management.

Aside from the overall measure, which LaFontana dubbed the "pain in the butt" index, Athenahealth also ranked insurers on variables like the time it takes to pay a claim and the percentage of claims paid in full the first time submitted. WellPoint finished fifth and sixth, respectively, in those categories.

It broke the rankings into national and regional sections and posted the results on its Web site, www.athenapayerview.com.

WellPoint's national competition included Louisville-based Humana Inc., which received the highest grade overall, Connecticut-based Aetna Inc. and Minnesota-based UnitedHealth Group Inc.

LaFontana said Athenahealth measured only insurers it works with and makes no claims that its study is statistically significant. The company works with doctors in 31 states and every region of the country.

"This is literally Athena's experience and Athena's data," she said.

WellPoint's performance didn't surprise Indianapolis doctors John Wernert and Chris Stack. They say slow payments have been a long-standing concern.

The insurer's payments can sometimes lag for three or four months, said Wernert, a geriatric psychiatrist and president of the Indianapolis Medical Society. This affects primary-care doctors in particular.

"They've got employees they need to pay and supplies they need to purchase, and when payments sit there for several months after the service has been provided, that affects their cash flow," he said.

These concerns aren't new. In 2002, for instance, Indianapolis-based Otolaryngology Associates complained to Indiana insurance regulators about payment troubles with WellPoint predecessor Anthem Inc.

Stack, an orthopedic surgeon who retired in 2004, said many doctors believe WellPoint sits on payments to let the money grow before sending out reimbursement.

The insurer does no such thing, Kappel said.

"It is a very high priority for WellPoint to continue to build very strong relationships with physicians," he said.

Kappel noted that WellPoint paid out $100 million last year in quality incentives in addition to regular reimbursements. He said the insurer also invests heavily in electronic claims processing, which speeds reimbursement.

The vast majority of its claims are filed electronically and 77 percent of those claims are automatically adjudicated, meaning software processes the claim from beginning to end with no manual intervention.

He said less than 4 percent of the claims filed with WellPoint take more than 60 days to be paid.

Every year, the company hires an independent contractor to survey doctor's office managers around the country, and Kappel said the insurer "consistently ranks higher than our competitors on overall satisfaction."

As for the Athenahealth survey, he noted that WellPoint processed more claims in one day last year than what the company used for its entire study.

"There's no way to draw any meaningful results from their analysis," he said. "There just isn't."

LaFontana said Athenahealth plans to improve on its debut. It will gather numbers every quarter and publish its rankings annually. Categories will change depending on the market.

The company wants to work with insurers to bridge the doctor-payer gap, not just embarrass them by publishing unflattering data. She said Athenahealth has had productive discussions with most of the insurers in its national rankings since it released the data.

WellPoint, however, is an exception.

"We remain very optimistic that we can build a collaborative relationship with them, but we haven't talked to them since the release of the data," LaFontana said.
Source: XMLAr00302.xml

Recent Articles by Tom Murphy

Comments powered by Disqus