BCBSIL/Orthonet Survey Results

BCBSIL/Orthonet Survey Results


The sample of respondents was not random; therefore, it is highly probable that we received responses from a greater proportion of Tier 2 and Tier 3 doctors than the total actual proportion of Tier 2 and Tier 3 doctors out of all BCBSIL tiered doctors.

BCBSIL has indicated that tiering would be based on a number of visits per patient. Keeping in mind our limited sample, the data we collected does indicate that per-patient visit averages were the key indicators. However, the correlation is not perfect. The overall problem is the lack of participation from Tier 1 doctors. Many simply are not motivated to participate or are concerned about potential repercussions for participating (thus, Tier 1 doctors have lesser participation). As a result, the survey does not provide enough information to indicate whether BCBSIL tiering was in fact based on a number of visits per patient. However, we are following up with BCBSIL in an attempt to confirm their stated basis of the tiering process.


Based solely on our informal sample, results are as follows:

  • Tier 3 doctors had 54% more per-patient visits than tier 1 doctors in a one-year period.
  • Tier 3 doctors also had 52% more visits per condition than did tier 1 doctors.
  • We also looked at a number of services. Although tier 3 doctors had more services per visit than both tiers 2 and 1, Tier 1 doctors had more services than tier 2.
  • Finally, we queried doctors about their use of certain codes. Tier 3 uses 97110 .24 more times than tier 1 per visit and .21 more 97112 than tier 1.
  • However, tier 2 doctors utilize massage therapy (97124) 36% more per date of service than tier 3 and 97140 1% more than tier 3.
  • We had 1134 surveys started and 550 finished.

We reiterate that these results are provided with the caveat that the survey was informal in nature and could not be conducted scientifically. We will continue to update our members as we receive more information from BCBSIL regarding the tiering process and the OrthoNet program.

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