Maryland physicians meet with payers on protocols
Baltimore, MD-Maryland emergency physicians are achieving breakthroughs in talks with managed care organizations (MCOs) over issues that have traditionally aroused anger and kept payers and providers at odds on patient policies.
Thanks to a 1997 Maryland law, emergency physicians have been meeting with representatives of the state's major health plans to develop a 24-hour telephone information access system.
The system will enable physicians to obtain prompt, relevant information, chiefly about a patient's primary care physician (PCP) or clinical specialist, that will help in making accurate assessments and ordering appropriate follow-up care.
"Our talks have been fruitful in that we've been able to convince health plans that it's in their own best interest to make this telephone access program work," says Larry Linder, MD, chairman of the public policy committee of the Maryland chapter of the American College of Emergency Physicians in Baltimore.
"The idea here is to try and keep the patient within the managed care plan by giving us access to that patient's panel provider," adds Linder.
Providers had long complained of frustrating delays when they've tried to reach payers concerning a patient's PCP or specialist. Under current conditions, frustrated physicians usually bring in an on-call practitioner at the hospital to see the patient if the MCO does not respond in a timely manner.
To address the issue, the law requires that an MCO respond within 30 minutes to an initial telephone inquiry about a patient or the on-call provider would be brought in. The statute also mandates that payers and providers convene an ad hoc committee to develop the system and have it operational by July 1.
The committee recently submitted a report to the legislature on the project's development.
"Did we agree on everything? No. But I think we all discovered that [payers and providers] have more in common than we do in conflict," according Robert Kritzler, MD, area medical director for Kaiser Permanente in Baltimore, who sat in on the meetings.
"It's been a good experience," Linder concludes. "We actually got a positive dialogue going," he adds.
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