Kerr EA, Mittman BS, Hays RD, Pitts J, Zemencuk JK, Brook RH; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 245-6.
Ann Arbor Veterans Affairs Center for Practice Management and Outcomes Research, Veterans Affairs Medical Center, Ann Arbor, MI 48113-0170, USA.
RESEARCH OBJECTIVE: The growth of managed care and increased prevalence of capitated arrangements for reimbursing primary care physicians have led to considerable change in the structure and operation of primary care medical groups. Responding to the demands of capitation, such groups have grown larger and have adopted more formalized management techniques for monitoring and enhancing achievement of key cost and quality goals. Many of these techniques fall under the broad heading of utilization management (UM) strategies, designed to influence physicians' resource utilization and clinical practice decisions in a manner consistent with the medical groups' norms and standards. Despite their prevalence and increasing importance, however, little information is available concerning UM strategies' effectiveness and impacts on key outcomes. We sought to determine the influence of various UM strategies on primary care physicians' satisfaction with the quality of care they provide and with other aspects of their medical practice. We hypothesized that UM techniques would adversely affect physician satisfaction to the extent that they imposed restrictions of physicians' professional autonomy and ability to practice without perceived restrictions, and to the extent that they represented the administrative burden. STUDY DESIGN: We surveyed 1138 primary care physicians from 89 California medical groups that previously participated in a survey of medical group UM strategies. Thirteen physicians were randomly sampled from each of the 89 groups; for groups with less than 13 physicians, all physicians were sampled. Physicians received a mailed survey containing questions addressing physician satisfaction, medical group UM techniques and selected physician and medical group characteristics. The survey packet included a $20 cash incentive and a cover letter explaining the survey's purpose. Nonrespondents received a second copy of the survey four weeks later, and follow-up phone calls. Multivariate analyses were performed to examine associations of UM strategies with physician satisfaction, controlling for key demographic and practice characteristics. UM strategies measured included preauthorization, denial rate and turnaround time for approval/denial decisions), promulgation of clinical practice guidelines, and delivery of educational programs regarding managed care. We focused on two key dimensions of satisfaction (multi-item scales): (1) physicians' satisfaction with their autonomy and the quality of care they are able to provide for capitated patients (two related aspects of satisfaction that proved straongly related in scale development), and (2) physicians' satisfaction with administrative responsibilities (e.g., paperwork) for capitated patients and with the support they recieve for these responsibilities. PRINCIPAL FINDINGS: Eighty percent of the physicians returned the survey. Respondents and nonrespondents did not differ with respect to age, specialty or board certification. Nineteen percent of the respondents were women, with approximately 60% of the respondents practicing in individual practitioner associations (IPAs) (vs. medical group practices). Just under 50% of the average physician's patients were covered by capitated insurance arrangements. Forty-nine percent of the physicians reported receiving capitated payments, 37% salary, 13% discounted fee-for-service and 2% productivity-based reimbursement for seeing capitated patients. Results of multivariate analyses revealed that both dimensions of satisfaction examined (satisfaction with autonomy and quality of care provided, and satisfaction with administrative matters) were significantly and inversely related to two key characteristics of preauthorization (precertification) techniques: turnaround time for decisions and denial rates. (For example, physicians in the 10th percentile for denial rate, corresponding to a rate of 1%, had a predicted satisfaction scpre of 53.4 on a 0-100 scale [SD=10, 95% CI 52.4-54.4], wheras physicians in the 90th percentile, denial rate=20%, had a predicted staisfaction score of 44.8 [95% CI 43.7-45.8].) The number of clinical decisions requiring preauthorization showed no significant relationship with either dimension of satisfaction, however. The medical group's use of clinical practice guidelines showed positive associations with both dimensions of satisfaction, suggesting that physicians view them as a positive rather than negative factor. UM techniques involving educational programs showed a positive association with satisfaction related to adminstrative matters but no association with satisfaction with autonomy and quality of care. (ABSTRACT TRUNCATED)
Publication Types:
Keywords:
- California
- Data Collection
- Efficiency
- Fee-for-Service Plans
- Female
- Group Practice
- Humans
- Income
- Managed Care Programs
- Physicians
- Physicians, Family
- Population Groups
- Professional Autonomy
- Specialties, Medical
- economics
- utilization
- hsrmtgs
Other ID:
UI: 102193705
From Meeting Abstracts