Maryland will survey MDs on HMO quality
Maryland HMO Reforms
Countless satisfaction surveys have gauged the quality of managed care plans from the consumer’s perspective. Physicians, who also are in an ideal position to assess the quality of managed care, have seldom been surveyed, but there is now growing interest in finding out how they rate the performance of plans.
"Physicians are on the front lines, and they can provide a lot of useful information," says Alan Hoffman, chief of HMO quality and performance for the Maryland Health Care Access and Cost Commission.
The Maryland commission, which provides consumers and purchasers with quality information through its HMO Quality and Performance Evaluation System initiative, plans to measure satisfaction among primary care physicians this year and report results in 1998. Mr. Hoffman says the state is interested in learning whether physicians can differentiate among plans based on quality.
If all goes according to plan, a pilot survey will be sent to primary care physicians this year, asking them questions about administrative features of managed care that may affect quality, including pre-authorization, case management and laboratory services.
"We’re not interested in finding out how happy the doctor is," explains Mr. Hoffman. "We’re looking to inform purchasers and consumers." He adds that the state does not want to focus on compensation issues either.
One major difficulty in surveying physicians is differentiating between their satisfaction with compensation from their satisfaction with quality. Another challenge is the potential bias physicians may have against managed care. In Maryland, respondents will be asked whether they would let a family member join an HMO The answers will help gauge physicians’ attitudes toward managed care. Getting physicians to take the time to assess all the plans they participate in is yet another hurdle.
"We think it’s important for consumers to know how their doctors feel about working with various managed care organizations," says Margaret Burri, deputy executive director of the Medical and Chirurgical Faculty of the State of Maryland. She noted that physicians and consumers share a number of concerns: access to specialists, reliable and efficient laboratory service and conveniently located ancillary services.
Health plan members are the "obvious users" of managed care services, she says. "Physicians traditionally have not been seen as consumers of plan services, although they are."
Not an easy survey
Several organizations, including the American Medical Association, have already run into difficulty in their efforts to survey physicians. The AMA launched what appeared to be a major effort last fall, when it mailed surveys to 100,000 physicians in 22 markets across the country. The thinking was that physicians’ views of health plans would be valuable to purchasers, plans and the broader physician community. But the response rate from the survey was disappointingly low, an AMA spokesperson reported, and it’s unclear whether the effort will be pursued. AMA officials declined further comment on the project.
A similar survey by the American Society of Internal Medicine (ASIM) in Houston, Tex. also was scuttled by a low response rate. However, another local survey of internists and neurologists by ASIM in central Florida netted sufficient replies for analysis. ASIM reports that Florida doctors didn’t give high overall ratings to any of the five plans in the survey, and most respondents said they wouldn’t recommend any of the plans they rated to a family member. (A summary of the survey analysis is available at ASIM’s World Wide Web site: www.asim.org)
The National Committee for Quality Assurance (NCQA) says it’s considered testing a physician satisfaction measure for possible inclusion in HEDIS (Health Plan Employer Data and Information Set). But it’s difficult to find good measures of physician satisfaction, a spokesman says, because compensation issues may influence physician satisfaction with quality.
Some managed care organizations survey their physicians internally as part of their ongoing quality improvement efforts. These efforts appear to be more common among network-style organizations.
Oxford Health Plans, an IPA based in Norwalk, CT, surveys its physicians every two years and disseminates the results within the organization. Surveys in 1993 and 1995 focused on six key areas: general attitudes toward Oxford; effectiveness of pre-authorization staff for clinical services; effectiveness of provider relations representative; evaluation of laboratory services; primary care physicians’ assessment of Oxford’s specialist network; and specialists’ assessment of Oxford’s primary care network. Oxford says it considers the survey an important tool for improving services.
Tufts Health Plan, a 660,000-member network-model plan based in Waltham, Mass., contracts with more than 14,000 physicians. "We have, as part of our philosophy, that our physicians are our customers, as well as our members," says Andrew Bergman, manager of clinical quality measurement and improvement.
Tufts’ annual survey gauges physician satisfaction with each administrative department in the plan. "In an IPA model, that’s important," Mr. Bergman notes. Not surprisingly, survey results identify speedy claims payment and an easy-to-use referral system as priorities for physicians. Tufts has responded by computerizing claims submissions and payment and developing an electronic referral system that is in use in some service areas, Mr. Bergman says.
Although the plan has not attempted to determine whether happy physicians correspond with happy members, "intuitively," he notes, "it makes sense."
—Mary Darby
Contact Mr. Hoffman at 410-764-3461, Ms. Burri at 410-539-0872, Mr. Bergman at 617-466-9425.
Maryland will survey MDs on HMO quality
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