It’s now up to the Senate to decide whether that suit will become moot. TH
Bryn Nelson is a freelance medical writer based in Seattle.
A Gloomy Assessment of Reimbursement Rates
This year’s healthcare reform legislation has generated plenty of uncertainty. One claim heard repeatedly during the debate over the legislation was that a more universal system would result in a fairer distribution of costs. That sense of fairness, however, doesn’t seem to extend to the expected reimbursement rates doled out to hospitals and doctors by private insurers. At least that’s the pessimistic opinion of healthcare executives surveyed as part of this year’s annual National Payor Survey, released by Santa Barbara, Calif.-based Revive Public Relations.
The intent of the survey seems to be a public airing of hospital executives’ grievances over the way in which reimbursement rates and claims are handled by the nation’s largest insurers, notably UnitedHealthcare (65% of 225 responding executives viewed the insurer unfavorably, actually a significant improvement over last year’s 82% unfavorable rating; the full report is available at www.revivepublic relations.com/reports.html).
Another set of survey questions, however, provides a glimpse of the gloomy expectations tied to reform. Only 35% of respondents said health reform would create more negotiating leverage for private payors over the next two to three years, while 47% said the legislation would yield less leverage. Two-thirds of respondents said private payor reimbursement rates would decrease over the same time period. Even more—68%—said that a reduction in care to uninsured patients (millions are expected to be added to federal and private insurance plans) wouldn’t make up for that shortfall in rates.
When asked by The Hospitalist, insurance representatives were more oblique in their assessments. UnitedHealthcare spokeswoman Cheryl Randolph took aim at her company’s unfavorable rating.
“We believe this selective, nonscientific, Web-based survey misrepresents the positive relationships that UnitedHealthcare has with most hospitals,” she said. But she didn’t directly address the matter of hospital reimbursements, instead citing “fair and reasonable reimbursement rates based on the market.”
Paul Marchetti, head of Aetna National Networks and Contracting Services (Aetna was the highest-rated insurer among hospital executives), says the reform legislation’s effect on rates isn’t clear, and invoked the challenge of how to effectively deal with healthcare affordability.
“We believe that the key to addressing the affordability issue is to reform our payment system to one that pays for quality, not quantity,” Marchetti said.
Most hospitalists would agree, but in the meantime, the quality-not-quantity principle does nothing to resolve the uncertainty over reimbursement rates.
Doctors might have to wait a few more years to see any positive movement, according to Jon Gabel, a senior fellow in the Washington, D.C., office of the National Opinion Research Center. Gabel points out that hospitals are still getting a better deal from private insurers than from Medicare (on average, reimbursement is about 20% to 25% higher). That means even poorly ranked insurers are likely to remain in the driver’s seat for now.
“As long as hospitals are well below capacity, and as long as private pay is the best paying form of hospital reimbursement—better than Medicare, better than Medicaid—it seems to me that it really won’t hurt the insurers’ business that much,” Gabel says.
Everything could change, Gabel notes, with fuller hospitals and less disparity between public and private reimbursements. “At that point, having a bad reputation is much more likely to impair insurers’ business,” he says.—BN