Member Forum

Expand all | Collapse all

quality measures for different insurances

  • 1.  quality measures for different insurances

    Posted 09-28-2018 11:03
    Hi, I run a small geriatrics practice with 2 providers.
    I have been participating in quality measures with united healthcare advantage successfully.
    However, now every advantage plan is starting their own quality measures.
    I am feeling overwhelmed and want to know what other people have done in such circumstances. Should, I cut down on the insurances I take?
    What are the advantages and disadvantages?

  • 2.  RE: quality measures for different insurances

    Posted 09-29-2018 06:24

    Thanks for sharing – an all too common scenario for docs.  I'd say drop all insurances ��

  • 3.  RE: quality measures for different insurances

    Posted 09-30-2018 14:35
     fortunately this  has become  a well known national issue and should improve
    The simplest answer is to be in a pho or ACO where you submit only one set of measures and often they make it easy

     Failing that IF they really  need you you may be albe to  talk to them about accepting MIPS measures or things you are already   collecting for others 
    How easy is it for your EMR to collect measures? If you collect everyone's automatically then  it is not so bad
    I do think you should speak up even if nothing changes  Because if you   do not they  will continue this.
    Also how much money is tied  to this 
    If they are collecting HEDIS measures that is for their benefit as a plan. IF you get money that is worth it  as ROI then you do it Maybe in other words you keep the plan but do not get a bonus  or whatever it is the  measures get you I mean what happens if you do not submit?MAybe you are so small they  keep asking but  there is no actual consequence to you

         Jean Antonucci MD
         115 Mt Blue Circle
         Farmington ME 04938
    ph 207 778 3313   fax 207 778 3544

  • 4.  RE: quality measures for different insurances

    Posted 10-01-2018 08:29
    I still participate with insurance, medicare, advantage plans, etc.   I do not submit quality codes, etc.   I did it for a year and then Medicare told me my practice was too small and I was not eligible for MIPS / MACRA etc.

    I agree with Jean that joining an ACO or similiar type organization may reduce the amount of times you need to submit data.

    But having said that, I have taken a somewhat , different approach to these requests.   Again, agreeing with Jean, my sense is the insurance companies are reimbursed far more by having the data then I am  for providing it.   So I respond to these requests with a form letter.  I will summarize it....

    We have received your request (see attached) for medical record information.   We recognize and fully understand the need for an insurance company to ascertain / assure quality of care for its enrollees.   You are welcome to have a representative come to our office to review the records at no charge.
    Alternatively, If you prefer, we can provide the information you are requesting.    There is a minimum fee of $75 per chart or $1 per page (whichever is greater).
    Please let us know how you want to proceed.

    There is sometimes some push back on the phone by an insurance company representative or the entity that has been hired to collect the data.    We just repeat the above statement.    The regional HMO, which has representatives in our area sends someone to our office.  The more distant companies pay us our fee.

    Have been doing this for at least 5 years.   Since this is now an annual request, and they usually just want data for the previous year, it is fairly easy for my receptionist / medical assistant to supply the data.

    So far, we have not been terminated by any plans.

    Michael S. MD