Managed Care Contract Negotiations
Oct 17

Put quality rankings in perspective

With the growth of transparency initiatives, many health plans have posted not only price information for individual providers, but quality rankings as well. Put these rankings into context for your patients so they have the proper tools to evaluate the information that health plans post. Consider the following:

  • Generate your own information packet. Distribute it to all your patients, providing an interpretation of the quality rankings that health plans have posted. If you have a Web site, post this information there as well.
  • Ensure that rankings link to pay for performance. Negotiate with payers to ensure that they tie to P4P measures any quality rankings they post or disseminate to the public. Make sure that the standards and data set on which plans base their quality rankings are truly auditable.
  • Argue for an all-or-none ranking system. Rather than publishing rankings for individual providers for a medical group, list the group as a whole if the majority of the physicians meet the payer's standards.
  • Negotiate your contract. During contract negotiations, incorporate terms about reviewing pricing and quality data. Argue that you should have the right to review any information before the plan releases it to the public so you can prevent misinformation. Your contract should also include provisions for appealing erroneous data. The provisions should define a notice period that states that once the provider gives the plan notice of incorrect data, the plan then has a set time frame to correct the data— or breach of contract will result.
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →