Contact:

Mary E. Nava

Director of Public Affairs

(210) 301-4395 ofc

(210) 382-6137 cell February 22, 2010

FOR IMMEDIATE RELEASE

BCMS Physician Survey Takes a Look at Health Plan Performance
Goal of survey was to identify areas for improvement

Recently, Bexar County Medical Society surveyed its physician members to gauge their opinion on the overall performance of 8 area health plans. The major health plans evaluated on the survey were: Aetna, BCBS TX, Cigna, Humana, Medicare, Superior, Unicare and United Healthcare. The results of the survey, which was conducted by the University of Houston – Clear Lake, include both a physician level and practice level analysis. Additionally, a “scorecard” was created to reflect the physician practices responding to the 28-question survey. The scorecard, similar to consumer reports, offers a snapshot of how the payors performed across all survey questions. Lee Revere, PhD, one of the primary researchers in the study, stated, “For many of the survey questions, each payor’s performance was statistically equitable; however, there were a few payors demonstrating areas of excellence while others showed a need for improvement.”
Survey findings:

Positive

Aetna, Cigna and Humana each performed statistically better than the group average across all the regional payors in three different categories. Aetna performed statistically better in the area of finding a specialist in the payor network, with none of the responding practices experiencing difficulty. Cigna performed statistically better in the area of preauthorization for services, with only 8% of respondent practices having difficulty with preauthorization. Humana performed statistically better in the area of email communication, with 63% of practices communicating via email to Humana.

Negative

Two health plans had one area that performed statistically worse than the group average. BCBS TX fell below the mean in the area of recoupment, with 27% of the respondents expressing negative experiences. Humana fell below the mean in the area of requiring excessive amounts of prescription drug preauthorizations, with 38% of surveyed practices having difficulties.

Medicare falls short in two areas: problems related to the filing of paper claims and use of the payor

website to find information. Forty-four percent of responding practices have problems filing paper claims while 33% report Medicare’s website as ‘not easy’.

One health plan, Superior, had five areas with performance that was statistically worse than the average

across all payors. Among the list of deficiencies: difficulties with preauthorization of services, difficulties obtaining referrals for patients, difficulties in finding specialists within the payor network, problems with the filing of electronic claims and problems with the timeliness of reimbursement. For Superior, 42% of respondents have difficulties with preauthorization, 36% struggle to obtain referrals, 24% have trouble finding an in-network specialist, 30% experience problems filing electronic claims and 45% do not get reimbursed timely.
Background

Bexar County Medical Society sent out 2,040 surveys to its members in active practice. Forty-two

completed surveys were received (including both individual and group practice responses), representing a total of 1,797 physicians. The total number of physicians represented includes the following specialties: primary care, medicine, medical subspecialty, surgical, surgical subspecialty, hospital based and other. In addition, the practice types represented include: solo practice, single specialty group, multispecialty group and other.

The Bexar County Medical Society, established in 1853 is the oldest county medical society in Texas and the eighth largest in the U.S. With a membership of more than 4,100 physicians representing all recognized medical specialties, the Bexar County Medical Society (and its subsidiaries) provides products, services and programs and operates 6 entities for physicians and their patients ranging from an online physician referral service, a medical credentialing service, to permanent and temporary medical staffing services. The purpose of the Bexar County Medical Society is to foster and maintain high standards of medical practice in the community and to promote the best interest of the patient and the public. Bexar County Medical Society members are active in physician and patient advocacy at the local, state and national level.