Maryland task force reviewing physician payment

Maryland physicians have invited the state to look closely at their wallets.

After years of lobbying by MedChi, the Maryland State Medical Society, a committee of health care experts, physicians, and representatives from the state and the insurance industry are meeting as members of Gov. Martin O'Malley's Task Force on Health Care Access and Reimbursement.

The task force is due to issue an interim report Dec. 1 to the governor and state legislators, and a list of final recommendations by June 30, 2008. Among the items the task force will consider:

• Potential legislative changes to reimbursement regulations.
• Clarifying or making legislative changes to the authority of the attorney general and insurance commissioner to regulate reimbursement rates and business practices of health plans.
• Recommendations as to whether to link reimbursement to quality measures.
• Recommendations as to whether companies should be allowed to require physicians to participate in all plans owned by a single company -- otherwise known as all-products clauses. (The AMA has policy against these clauses.)

The task force is scheduled to meet monthly.

A study done by the Maryland Health Care Commission in 2004 found that Maryland physicians' reimbursements were in the lowest quartile of the nation.

Physicians are leaving the state, and will continue to do so, seeking better pay, said Martin Wasserman, MD, executive director of MedChi, and a member of the task force.

"There's going to be a pretty thorough review, and at end of day they're going to find out our doctors are undercompensated," he said.

Maryland Secretary of Health and Mental Hygiene John Colmers, MPH, is chair of the task force. He said because the state can't change Medicare reimbursement and has already addressed Medicaid reimbursement to bring it in line with Medicare, the task force will be mostly focused on health plan reimbursement. In that arena, he said, "There's no direct state authority; it's more indirect."

Dr. Wasserman said a lack of private insurance competition in Maryland has depressed physicians' reimbursements.

"As we look ahead and find out that medical school graduates are going to be declining and there will be competition for them, Maryland will find itself -- if it doesn't act -- not able to meet the need of the citizens," he said.

CareFirst BlueCross BlueShield Interim President and Chief Executive Officer David Wolf is one of the 14 members of the task force.

CareFirst spokesman Michael Sullivan declined to comment on Wolf's membership or whether CareFirst is open to raising reimbursements based on task force findings.

But Sullivan said Wolf's comments to the Baltimore Sun that higher reimbursement would make care more expensive for patients were "accurate."

Colmers said Wolf is a needed voice on the task force.

"In order to get a balanced view from both those who are responsible for paying the bills and those responsible for providing the services, we need to have a balanced set of opinions," he said.

Dr. Wasserman agreed that it's important insurance companies be part of the task force, but he said he is under no illusion that the findings will prompt health plans to boost physician reimbursement willingly.

Meanwhile, a few days after the task force's first meeting, the Maryland Insurance Administration announced that it was fining CareFirst BlueCross BlueShield, based in Owings Mills, Md., $125,000, and ordered the company to review denied claims.

The state found, in a market conduct examination of claims from 2004, that the company failed to process 15% of about 1,700 denied claims sampled within the legally required 30-day window.

CareFirst signed on to a consent order agreeing to fine and correct the problems identified in the state's report.

"We have and are continuing to work with the [Massachusetts Insurance Administration] to address the issues," CareFirst spokesman Jeff Valentine said in a statement. "We continue to review our processes to more effectively handle claims."

He said the company each year processes 99% of more than 30 million claims within 30 days, and had addressed some of the cases found in the market conduct study.