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Spurred by the frustration of their physician members, nearly two-thirds of state medical societies are now keeping detailed databases, or "hassle logs," tracking the specific problems providers are having with managed care organizations, says the American Medical Association (AMA). As the logs grow larger, providers hope to use this information to push managed care organizations (MCOs) and state insurance regulators to introduce reforms.
In Texas, for instance, the state medical association is using information gleaned from its members to lobby insurers to negotiate changes involving slow payments, bundling, downcoded claims, and administrative hassles on both a broad policy and individual case basis.
The Illinois State Medical Association launched a managed care hassle log last year, notes Ronald L. Ruecker, MD, the state society’s president and an internist in Decatur, IL. "We weren’t sure what to expect, but we’ve had a very positive response," says Ruecker.
The Colorado Medical Association uses its hassle log to set the agenda for regular bimonthly meetings with representatives from managed care companies, notes spokesperson Edie Register.
Its approach is to have doctors fill out a hassle form detailing their problems. The form is submitted along with documentation that the society’s staff use to determine if the problem lies with the provider or the plan — or both.
The results are then complied into a quarterly report that is sent to managed care plans and the state insurance department. The idea is to pressure the plans — without taking a directly confrontational approach — to look into the problems being presented and resolve them on their own. If that does not work, the association will turn up the heat by formally requesting the state insurance department to investigate its findings.
The top managed care issues for physicians, as reported by state medical societies, are: