Managed care: A new way to report hassles

The AMA has created a physicians-only online form to report problems with health plans.

Editorial. Dec. 24/31, 2001.

Most physicians are well acquainted with managed care hassles. Most physicians have access to the Internet. These two heretofore unrelated realities of modern medical practice come together nicely at a new AMA Web site: an online, physician-only complaint form to report problems with health plans.

It is a fast, easy and confidential way for physicians anywhere in the country to tell the AMA what insurer hassles they are encountering, especially with managed care. The site then allows the AMA to gauge the frequency of specific problems, discover what health plans are involved and which geographic locations are hot spots. The resulting data can be used by the AMA in its efforts on behalf of patients and physicians to curtail health plan abuses.

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This site was created by a directive of the AMA House of Delegates, acting on a resolution brought last year by the American College of Physicians--American Society of Internal Medicine. It represents the latest move by the AMA to back up physician advocacy about managed care with data that go beyond the anecdotal. Shortly before the launch of the Web site, the AMA presented a benchmark analysis of managed care competition in 40 large metropolitan managed markets and 19 state markets. That report shows that in many markets, a single insurer controls too much of the enrollee market -- oftentimes more than half -- suggesting the need for reforms that would allow physicians to stand up to plan dictates and actions.

The list of just what plans have been getting away with is the focus of another AMA report, from earlier this year, that compiled insurer hassle data collected by a number of state and local medical societies. These problems -- such as prompt-payment issues, administrative hassles, downcoding, medical necessity denials and bundling -- are expected to play prominently in results of the national online survey as well.

In fact, physician visitors to the online complaint form are presented with a list of about three dozen common complaints that they can check off with the click of a mouse. Doctors also will find drop-down menus for identifying health plans and providing other information. The form has provisions for physicians to enter in specific Current Procedural Terminology codes at issue in disputes with health plans. There are also boxes where physicians can type in additional detail or report new types of hassles.

What the form doesn't ask is the doctor's name. The reporting is confidential, and only basic demographic data such as city and specialty will be collected on the form. But to ensure that the information is coming from the medical community, the AMA requires use of the AMA Internet ID to access the complaint form. The registration for the digital certificate is free to all U.S. physicians and medical students, AMA member or not. (And its uses go far beyond the complaint form. It allows physicians better use of the Internet by electronically certifying that they are, in fact, medical doctors).

The site is now open for business, and, unlike many of the insurers physicians will be reporting on, there's no wait for service.