The national physician survey finds gatekeepers uncomfortable with expanding role.
Dr. Survey / Managed Care
A nationwide survey of physicians is putting a new twist on the issue of access to specialists in managed care, an issue that is often viewed as one of patient choice. According to the survey by the Center for Studying Health System Change and Mathematica Policy Research, Inc., a significant number of primary care physicians (PCPs) are uncomfortable with the expanding scope of services they provide to their patients.
Nearly one-third of primary care physicians report that the scope of care they provide to their patients has increased over the last two years, according to Robert St. Peter, MD, senior medical researcher for the Center for Studying Health System Change and project director of the national physician survey.
Nearly one-quarter of primary care physicians report that the complexity or severity of patients’ conditions for which they are expected to provide care without referral is greater than it should be.
The Center plans to release results from the full physician survey this fall. A total of 12,600 physician interviews, addressing a variety of health system issues, will be analyzed. Dr. St. Peter’s preliminary findings on physicians’ scope of practice are based on interviews with 4,978 primary care physicians and 3,976 specialists.
Specialists saw the trend as even more pronounced when asked about the scope of services provided by primary care physicians. About 50% of specialists believed that the scope of care primary care physicians provide to their patients has increased over the last two years. Some 38% of specialists feel that the complexity or severity of patients’ conditions for which gatekeeper physicians currently are expected to provide care without referral is greater than it should be.
"Appropriate steps should be taken to ensure that all primary care physicians receive the training and support necessary for them to meet the increased demand for their services," concludes an abstract on the study which was presented at an Association for Health Services Research meeting earlier this summer.
While the debate over access to specialty care is over turf and revenue, it also is over whether there are better outcomes when patients receive treatment by specialists. "Treatment is usually cheaper by a PCP," he says. "However, some people argue that while there is more expense up front with a specialist, it’s more cost-effective to use them in the longer run. There is also the issue of patient access and choice. They’re used to having it."
Coalition for access
Debbie Havens, chair of public relations for the Patient Access to Specialty Care Coalition, a coalition formed last year, agrees with the Center’s general finding: "PCPs believe they are working beyond their scope of care at times," she says. Studies show that when patients get to specialists such as neurologists for stroke, endocrinologists for diabetes and allergists for asthma, patients fare better and the care is more cost-effective than the care received from a PCP. The Patient Access to Specialty Care Coalition includes 130 national organizations representing consumers and providers, ranging from the Allergy and Asthma Network/Mothers of Asthmatics, Inc. and the American Academy of Allergy and Immunology, to the Society of Thoracic Surgeons and the United Ostomy Association.
The issues supported by the Coalition include bans on gag clauses and access to specialists at affordable rates. Not only should consumers have access to specialists outside the health plan’s network, the Coalition believes, but the added cost of this option is modest and should be passed along to the consumer as such.
The Coalition, which has conducted surveys of consumers, maintains a Web page(http://home.patient access.com/pac) with information on how consumers can evaluate their health plans and secure their rights. The Web pages advises consumers to call a toll-free number (800-756-1100) it staffs to "register your concern about the quality of your health care."
"As MCOs offer more point-of-service plans they’re making a step in the right direction," says the Coalition’s Ms. Havens.
"The bigger and better plans are moving that way and using choice’ as part of their marketing strategy."
Some HMOs have gone further by relaxing their gatekeeper standards. For example, this year Oxford Health Plan began allowing members to bypass their PCPs and self-refer to specialists in the areas of behavioral health, oncology, orthopedics, urology, obstetrics/gynecology, cardiology, gastroenterology, neonatology, neurology, nephrology, and ophthalmology. And CIGNA Healthcare now no longer requires its members to obtain PCP referrals for obstetrical and gynecological services.
—Marc Grobman
Contact Dr. St. Peter at 202-484-5261 and Ms. Havens at 202-544-1880.
The national physician survey finds gatekeepers uncomfortable with expanding role.
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