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Creating Payer Report Card Tips
- Don’t create a report card for every payer—focus on those with the greatest volume or revenue:
“Take the top ones that make the significant chunks of your revenue, which might be typically in most hospitals five to seven [payers], and start to measure those. Don’t go down to the minutia where there’s no ROI,” says Maria Todd.
- Measure payer performance against the actual terms of the contract, not what you should have negotiated:
“If there’s a state law that says the payer must pay within 45 days, and it pays in 44 days and there’s nothing in the contract requesting faster payment, then the payment is according to contract, and that gets an A,” says Maria Todd. “But, if the payer paid in 45 days, then that gets a C, because it’s average, not better than what the contract says.”
- Don’t over-measure; make sure that your metrics are relevant to your goal:
“You may have certain factors based on the payer mix that are more appropriate to monitor in one versus another market,” says David Livingston. “For example, if you’re in a market with a lot of consumer driven health care, you might want to look at the bad debt by payer closely. If you’re in a heavily HMO market, you might want to look more closely at denials and the percentage of these denials overturned on appeal.”
- Use statistically valid data:
“Before you present it to a payer, make sure you understand and are confident in your data,” says David Livingston.
- Don’t necessarily issue a grade:
“We don’t try to summarize or give an overall grade,” says Richard O’Donnell. “But for each of the areas we do give an indication, anywhere from zero to three thumbs up, of how well the plan, we believe, is achieving excellence.”
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