Health Information Management

News: Nations largest insurers change physician payments

CDI Strategies, February 16, 2012

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UnitedHealthcare became the latest private insurer to announce plans to tie its reimbursement to quality measures, according to a February 9 Wall Street Journal article.

Rates of readmissions, use of radiology services, mortality rates for certain conditions, hospital-acquired infection rates, as well as patients' satisfaction measures may be among the measures UnitedHealthcare will tie to pay for hospitals. CMS similarly rolled out such measures in its fiscal year 2012 Inpatient Prospective Payment System.
 
UnitedHealthcare’s quality measures for physicians could include patient admissions, emergency-room use, and total cost of care, as well as the rate of patients receiving recommended screenings, the Wall Street Journal reports.
 
In January, WellPoint Inc., announced that it would increase pay for primary care doctors by 10%, and attempt to enhance its information networks to support quality of care, according to an article in January 28 San Francisco Chronicle.
 
WellPoint’s initiative centers on primary care physicians in an attempt to keep patients from entering emergency departments to begin with, according to the San Francisco Chronicle, and may help reduce repeat admissions, and costs for the insurance giant overall.
 
Also in January health insurance giant Aetna Inc., announced that it would start paying its primary care physicians additional payments per month, per patient, if certain quality and coordination standards are met, the Wall Street Journal reported on January 27.



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