Andy Slavitt, Ingenix

So we're going to start with one of the more controversial people I'm meeting at HIMSS, Andy Slavitt the CEO of the newly discovered and reviled by the Senate Ingnix. As you may recall, despite the fact that (not entirely to Andy's pleasure) I called them arms dealers, I was not entirely unsympathetic to what Ingenix was up to in the recent mess. So I talked to Andy about that, about what Ingenix actually does and whether it made sense for a health plan to own a big informatics company (his short answer…they don't!) An interesting interview you can see immediately below.

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  1. Sue O writes:
    > A lot of patients choose to be informed
    Well, Sue, I don’t know where you live, but methinks this behavior is most atypical.
    As for what physician they see: if the patient has a PPO style plan, he’s almost certainly quite well-served seeing a doc in-network and then everything will work out fine with no surprises. If a patient wants to see an out-of-network doc, well, then, he should accept the fact that he’ll be paying a good chunk out of pocket. One presumes that the patient had a good reason for choosing an out of network doc, and even a few hundred bucks for a consultation won’t break the bank for most people. He shouldn’t whine about the reimbursement to him from the insurance company being “low”.
    If a patient has a more-or-less straight indemnity plan, he ought to call ahead and ask about charges. But now I’ve wrapped around to the top where I started…

  2. I don’t know if Ingenix “manipulated” the data or not. If they did, they shouldn’t have. But, I do think the MDR premise is a good one and a necessary one. I know that physicians don’t like to be held to billing standards, but there has to be a standard or healthcare costs will be totally out of control.
    If all charges are collected in a database based by CPT code this sets what is usual and reasonable for a certain charge by geographical area. I don’t care how special you think you are, you shouldn’t charge double what the doctor down the block charges for the same service; especially something as simple as a blood draw or 15 minute office visit. There HAS to be a standard.
    This IS valuable information for patients. They need to be aware of what their physician is charging them and take an active part. A lot of patients choose to be informed and call their physician’s office ahead of time to find out what the basic charge for an office visit is and then they call the insurance company to make sure that it is within usual and customary. They SHOULD know upfront if they are going to a physician that charges over the normal so that they can make the decision whether they want to go ahead and be treated by this physician knowing that they are going to be responsible for costs over what the insurance will pay.

  3. FL PCP writes:
    > If you think Ingenix is providing valuable
    > information for patient care, then perhaps
    > you are part of the problem, not the solution.
    Perhaps. On the other hand, patients pay the insurance premiums ultimately, and so they’re interested (or should be) in their insurers cutting them the best deal they can get.
    Ingenix gave in quickly because the value’s in the analytics, not in the data management. Sure, turn that over to whomever wants it so long as we can still get the data! I’ll be you that nothing changes when the politicians get their “independent” data collection up and running. And OF COURSE Cuomo has no conflict of interest, requiring the agency be located in New York. Let’s watch to see who exactly gets the contracts and the jobs.
    > Federal Trade Commission Summary Complaint
    This complaint is ENTIRELY unrelated to the Ingenix pricing data thing. They’re evidently not sending one of those “form letter” notifications we all see once in awhile at home from Fidelity or from a former employer’s pension plan or the bank or whatever. Ingenix will pay a fine and start sending a “Notice To Users of Consumer Reports: Obligations of Users Under the FCRA” document to their customers (i.e. insurance companies), and that’ll be that. Yawn.

  4. With all due respect to Tom, Ingenix’ motives are clarified not only the media, but also by physicians (BTW, we care for the patients). Clearly “purchasing agents” (twice referenced) means insurers. “Transparency” has no real value to patients, since insurers determine reimbursement. True transparency would mean listing CEO compensation, shareholder returns and Health Underwriter’s profits on the EOB.
    Here is a small sample of the contribution Ingenix makes to healthcare:
    Educated Opinion from zdnet:
    Ingenix, a unit of UnitedHealthcare, has settled a fraud case filed last year by New York attorney general Andrew Cuomo that has repercussions across the medical industry and should ripple across technology as well. Cuomo had charged Ingenix with posting phony rates in its database, so that a $100 office visit might be reimbursed as a $72 visit, leaving the patient with a bill for the remainder. The case started in 2006 when Columbia lecturer Mary Jerome complained she was left with tens of thousands of dollars in bills for ovarian cancer treatment, despite having full insurance. Under the settlement, estimated at $50 million, UnitedHealth will create a new database on out-of-network rates, which Cuomo wants based in New York. Ingenix is based in Minnesota. UPDATE: Add another $450 million to AMA doctors, and $20 million from Aetna to fund a non-profit alternative to Ingenix. Investors are shrugging off the news. UnitedHealth is currently trading very near the level it was at when the case was first filed, despite the Wall Street crash which came in the interim. Critics will say that, since UnitedHealth may have made more than $50 million from the fraud it is getting off lightly. But Cuomo also promised to go after every insurer using Ingenix, and the result could decimate the unit. This just as it was trying to launch a consulting arm trading on its good name.
    Wall Street Journal article:
    UnitedHeathcare unit charged with fraud: http://www.marketwatch.com/news/story/new-york-state-charges-unitedhealths/story.aspx?guid={A6E79417-6D6C-48EE-9DC0-BB52F816DB09}
    Federal Trade Commission Summary Complaint:
    If you think Ingenix is providing valuable information for patient care, then perhaps you are part of the problem, not the solution.

  5. Andy Slavitt does a respectable job addressing the current cloud of bad will circulating around Ingenix. I always wondered what ever happened to MDR; use to pay at the 75th percentile once upon a time before RBRVS conversion.
    I might note that the pricing database to which Andy referred with considerable history pre-dating the Ingenix acquisition, was compiled in a “usual, customary and reasonable” (UCR) charge based context. To say that this pricing methodology was “physician friendly” would have been to understate it’s nature.
    UCR pricing methodologies generally treated physicians very well; so his argument is on sound footing.
    Docs would jump for joy today if Ingenix’s out-of-network pricing benchmarks were used vs. conversion factors or multiples thereon.

  6. FL PCP writes:
    > at the end of the day, their data-slathered
    > info-mall offers nothing to patients or doctors.
    Nonsense. Ingenix offer a great deal of pricing transparency to patients and their purchasing agents. This is quite valuable to patients and their purchasing agents.

  7. I viewed the very interesting interview with Ingenix CEO Andy Slavitt. I am regularly fascinated by the Numbercruncher’s ability to evaluate physician reimbursement based on the multitude of nuances in any given office visit. While I respect their computational prowess and their penchant to attempt to quantify physician behavior, at the end of the day, their data-slathered info-mall offers nothing to patients or doctors. It is merely a complex data management system designed to limit physician compensation and erode the doctor-patient relationship. It adds to little value to medicine, but certainly adds value to the bottom line of major insurers.

  8. `twill be interesting to see if the new not-for-profit compiler of physician fees comes up with anything different.