Physician tiering is another method payors are utilizing to stem rising healthcare costs. This system ranks physicians based on quality and cost. Depending on physicians’ rank, patients’ out-of-pocket costs can widely vary.
Attempts to drive down costs will most likely continue. According to a report by CNBC, Americans spend significantly more per capita on healthcare than any other developed nation. By 2023, the projected per person expenditure will be almost $15,000.
Source: CNBC and CMS
Theoretically, physician tiering doesn’t limit patient access. The upper-tiered physicians are still in-network. However, the patients’ out-of-pocket costs to see one of those physicians, rather than a lower-tiered doctor, will be much higher.
The Problem for Dermatologists
The tiering criteria used by payors is not specialty specific. Dermatologists are being judged by standards that simply don’t fit. A recent Dermatology World article titled Purse String Policies discussed this issue and how, with the current physician tiering methods, dermatologists’ ranking is actually based solely on cost.
Quality dermatological care is not a commodity. Each case must be treated based on the specific circumstances of the patient. To accurately rank dermatologists’ quality and cost, the AAD argues, payors need to analyze outcomes data.
Negotiating with Accurate Data
Healthcare consumers are being not-so-subtly steered toward lower-tiered physicians. Some payors’ websites organize their provider networks by tier. Members are encouraged to choose a physician that provides the best value. While value may be subjective, a side-by-side comparison of out-of-pocket costs is sure to influence patients’ choice.
The best way for physicians to ensure they are tiered correctly is to provide their own quality and cost data during payor contract negotiations.
QualDerm’s IT team works with our affiliated practices to capture and analyze quality and cost data. This data has successfully been used to negotiate more favorable terms with payors. It is also used to meet MACRA reporting requirements. Additionally, QualDerm has other proprietary analytics reports that help protect our affiliated practices against narrowing network policies.
Learn more about how partnering with QualDerm can help you position your practice for sustainable growth and profitability.
Contact us to find out more about partnership opportunities or to discuss selling your practice.