Posts tagged with ingenix

Those of you who have the misfortune of having spent time with me know that I tell a lot of stories, often more than once. I also use the same punchlines a lot.

One little routine I've inserted into seminars, phone calls, and lunches a thousand times over the last decade is the UHC/Ingenix piece. "Sure, there is another place where you can get some of the data I'm talking about - Ingenix. You know who owns them, though, right?" Very few people have ever known before I told them.

I have always felt compelled to share my discomfort relating to the Ingenix data, before I even knew about the UHC connection. I remember buying that expensive CD program in order to look up pricing information. Remember that feeling from in your practice management education: "Holy cow, to do this right, I need a lot more data and these people have it on a silver platter!" In fact, they were my inspiration for creating the RVU calculators - I felt it a bit ridiculous that pediatricians should have to pay for RVU information.

Anyway, there are parts of the country where PCC has a concentration of customers or extra knowledge about a local market. Here in Vermont, for example. Or San Antonio, northern NJ, Tulsa, etc. Every time I checked the Ingenix software for the "usual and customary" prices...they just seemed lower than what I would have expected. Had they simply been different, some high and some low, I'd have understood. But it's always low. If there are only six pediatric offices here in our county and I know the prices to all of them, and Ingenix reports a lower median price - how is that?

Here's the other question: where does this data come from? How does UHC/Ingenix get CPT/pricing level data from places like Vermont, where they don't actually have a presence? Doesn't that seem odd? If the data isn't for sale (gross!) then how are they getting it?

For that random person hitting this blog who doesn't know what I'm talking about, you can hear NPR's take on Andrew Cuomo's investigation of UnitedHealthCare. Better, check out NY's press release. My favorite quote from it:

Cuomo’s investigation also found a clear example of the scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance.

The real question: is anyone surprised?

Update: the NY Times has finally gotten into the commentary.  My bet? This goes nowhere important.

Just as Dr. Stoller hit PedTalk with the info, I was reading the teaser over on FierceHealthcare:

Now, a consumer is raising the stakes a bit by attempting to get class action status for a suit against Ingenix itself.

I've written about my experience with the Ingenix "data" and their relationship with UHC, though I did conclude that this issue would go nowhere. Now that a consumer has gotten in on the deal, perhaps I'm wrong. I can only hope.

In the good news department, get this: Oxford just announced that they are changing the way their policy updates are communicated on-line. Instead of just listing the policies, they are providing a summary for each (like Aetna). This is much more human-friendly and will go a long way to improving their scores in the Verden Report. Given the proximity of this action to the release of the data which shows them scoring so poorly, I can only wonder what the coincidence level is. I'd like to think it was the Verden Group that pushed this into happening. Oxford would, of course, tell us that they have been working on this "for months" I am sure.

It's Friday, I have a head-cold and sore throat, and all the pressure of farm/T-ball coaching has gotten to me. So, today, I am going to let someone else do all the work.

Head over to Crossover Health, where Dr. Shreeve has picked up on an announcement from the Ingenix CEO that they will open-source their tools. I mentioned this to John Canning and his immediate response was, "Sure, open the tool set and sell the data." Gillette/Burma Shave proved the success of this model a long time ago. I, too, share his and Dr. Shreeve's cynicism (in fact, I don't think the latter is cynical enough). Time will tell, though. Fascinating read.

Andrew Cuomo, you are my new friend.

It’s also nice to feel vindicated.  Lynn Cramer, pay attention - this relates to your questions to me about St. Anthony’s RVU values.  For anyone who is using St. Anthony’s or Ingenix to set prices, etc., pay attention here!

Ingenix, owned by United, settled with the state of NY and will be overhauling its data-gathering effort. I wrote about how my experience with their data made me feel like they were cheating.  And now we know they were.

Here’s a highlight from the article below:

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

You can read the entire thing at the NYTimes here, I’ll excerpt the first part of the article below (I recommend reading the entire thing, it’s quick).

In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.

The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected…(keep going)

Finally, don’t forget: we are moving to pedsource.com/chipsblog!

I forgot to mention last week that I updated the Build Your Own RVU calculator for 2009.  You can find it and the instructions in the PedSource library.

To make a long story short, for those who don’t know it - I really don’t like the fact that do do any proper RVU analysis of your practice, you have to pay for expensive software.  Especially for software owned by organizations who have admitted to ripping off the very people they claim to serve.  So, I designed a free tool that, using the license for which you are granted permission to access CPT codes (thanks, greedy AMA), you can do the calculation work you need.

Share and enjoy.  Flash-based pediatric coding tool coming soon, I hope.