May 2, 2007—The second annual PayerView rankings, issued today by athenahealth Inc, Watertown, Mass, and Physicians Practice, Baltimore, reveal alarming payment and administrative inefficiencies in some state Medicaid programs that could cause access problems for millions of Americans.
The rankings indicate that major contributors to some state Medicaids’ overall low performance may be attributed to slow—or, in some cases, nonexistent—reimbursement policies by state programs and the growing trend of some states outsourcing Medicaid programs to underperforming private managed care organizations.
“We are seeing disturbing administrative process breakdowns with some state Medicaid plans that are resulting in a growing number of physicians no longer accepting new Medicaid patients,” said Jonathan Bush, Chairman and CEO of athenahealth. “These alarming new trends point to a potentially dangerous access-to-care issue that is surfacing for more than 50 million Americans enrolled in state Medicaid plans.”
athenahealth and Physicians Practice looked at 12 state Medicaid plans’ performance across 7 performance metrics. They found that New York-Medicaid was the slowest payor to providers, averaging more than 111 days to process a claim; that Illinois-Medicaid only pays medical claims on the first attempt about 30% of the time; and that Louisiana-Medicaid rejected claims or required back end reworking by medical practices 48% of the time.
“There is a vigorous national debate on Medicaid underway around whether to reduce or expand funding,” Bush said. “What is missing from this dialogue is the acknowledgement that precious health care dollars are being wasted on arcane and inefficient administrative processes in some state Medicaid programs.”
—Cat Vasko
