AMA Supports Recommended Medical Loss Ratio Rules
The American Medical Association and state medical societies are supporting a proposal by the National Association of Insurance Commissioners on what expenditures insurers can consider medical spending under the new health law.
"Starting next year, insurers will be required to spend 80% of the premiums they collect for individual and small-group policies on patient care and quality improvement -- 85% of premiums for large-group policies," American Medical News reports. The draft proposal, unanimously approved by the NAIC, guides the federal government on how to classify particular expenditures when determining medical-loss ratios.
"Health plan activities that would count as quality improvement include comprehensive discharge planning, case management, care coordination, chronic disease management, and health information technology expenses related to preventing hospital readmissions and reducing medical errors. Insurers would be able to consider costs associated with certain public health education campaigns to be in the wellness and health promotion category, also a medical expense. But health plans would not be able to consider fraud prevention and detection efforts when it calculates its medical expenses." Insurer expenses "associated with the implementation of the new International Classification of Diseases code sets ... the next generation of diagnostic codes that physicians and health plans will need to adopt" would also be excluded (Silva, 8/30).
Meanwhile, as physician practices step up hiring, many are "contemplating matters of employee pay," American Medical News reports in a second article. "Fair compensation should not be the only factor physicians consider when determining salary and benefits, according to experts. Practices must determine a figure that ensures employee retention and offers flexibility to allow for future raises." Experts suggest "assessing data, benchmarking salaries and benefits, and defining job requirements and goals" (Elliott, 8/30).