Observation Deck

Insurers: Let’s End Exclusion

It’s time for private health insurance to quit hiding behind accreditation.

• By Mary K. Nicholas
• Nov 01, 2011

If healthcare is truly, 100 percent committed to the quality of care for the beneficiaries, patients, caregivers and employers that pay for it, then insurance companies need to develop their preferred provider contracts based upon the quality offered by the healthcare provider or supplier, not by whomthey are accredited with.

To exclude suppliers based upon their accreditation credentials is like telling a person they cannot join your association because they have a “T” in their name, or because they drive a blue car. There have been some very disappointed suppliers as of late who have contacted me because they are facing a potential substantial loss of their business with a third party insurance contract, all based upon who they are accredited with.

If one really thinks about this situation, suppliers, and potentially great suppliers, are being excluded based upon a choice that was made and offered through a huge government contract commonly known as Medicare. Talk about a rock and a hard place. Suppliers who chose an accreditor at a time when tens of thousands of suppliers were mandated to achieve accreditation, now find themselves on the short end because they didn’t choose the “correct” one in the eyes of the insurance companies. Even accreditors that have been deemed qualified by CMS are being discriminated against.

Come Out, Come Out, Wherever you Are!

To these private insurance companies I say, “quit hiding” behind the accreditation certificate and look at each supplier for who they are, who they serve, what products they offer, and how efficiently they offer service, equipment and delivery to their customers. I say to ask the suppliers to submit their customer satisfaction surveys, their quality improvement reports, their compliant logs, their billing accuracy, and so on. I say to those insurers, “conduct your own satisfaction surveys” to ensure patients are satisfied with the suppliers who they have worked with. I would bet that those insurers will find excellent, dedicated, patient-focused suppliers that they might have previously excluded previously because they “drive a blue car” or “have a ‘T’ in their name.”

Let’s face it, accreditation and the standards that are imposed are only as “alive” as the organization that breathes life into them. Sure, there are differences in how each of the accreditors impose their standards and observe their implementation, but the bottom line difference is the owner that maintains quality on a day-to-day basis.

It’s time insurance companies really truly look at who they are signing contracts with, and not hide behind discriminatory decisions based on who they are accredited by. It’s time that they admit that “choice by accreditor” is an exclusionary tactic that, frankly, is unfair and illogical.

I know I am edging a bit close to discomfort when I say that “choice by accreditor” seems not so far away from denying someone a membership because of their religious or educational affiliation. It’s a stretch, I know. But I am mad. Mad on behalf of the thousands of customers/providers/suppliers that in good faith made a choice that was 100 percent acceptable in the eyes of the public healthcare system, only to find out that the same choice creates exclusion in the private healthcare sector. What sense does that make? Does private healthcare do a better job? Does private healthcare guarantee higher quality? I think it would be tough to prove.

Double Dare Them

What I do think is that all suppliers who have been denied contracts should revolt and dare the insurance companies to look at their quality systems, patient satisfaction, billing efficiencies, complaint logs, referral source satisfaction, and so on. Suppliers can prove that on their own merits, they should be considered for contract opportunities. Dare the insurance companies to look past whose name is in the “Accredited By” line, and to look inside the organization at its quality of service, commitment and equipment.

And I dare the insurance companies who use accreditation as their sole determinant for approvals, to develop criteria to ensure the suppliers are of the quality and distinction that is required, and to quit using accreditation organizations as the bargaining chip. They don’t know what kind of quality they are missing and, ultimately, their beneficiaries lose out.

How can it be said that insurance companies care about quality when potentially high-quality suppliers are being excluded? Insurers, quit hiding behind accreditation certificates and demand proof of quality from your potential preferred providers. Isn’t that the most logical and important?

This article originally appeared in the November 2011 issue of HME Business.