Magazine article Medical Economics

Doctors Help Foil 'Mystery Shopper' Plan

Magazine article Medical Economics

Doctors Help Foil 'Mystery Shopper' Plan

Article excerpt

A few weeks ago, I was called by a colleague who was interviewed for a New York Times article about the federal government's plan to deploy a team of "mystery shoppers" to pose as patients and call doctors' offices in nine states to see how difficult it was to get care. It sounded to me like a spy novel or paranoid fantasy.

According to the article (see "U.S. plans stealth survey on access to doctors," June 26, 2011, http://www.nytimes.com/2011/06/27/ health/policy/2 7docs.html), the individuals were to pose as new patients, calling on the phone up to three times. They were to ask doctors' offices for expedited appointments. Government officials said they wanted to know whether the "patients" received different answers depending on whether they had public or private insurance, or were self-paying. The purported goal was for the federal government to identify whether doctors' practices can accommodate the purported millions of people gaining health coverage under the Patient Protection and Affordable Care Act.

ONLY OPEN TO SELF-PAYING PATIENTS?

Frankly, I had hoped that if the plan had taken place that they would have found that the physician offices surveyed were only open to self-paying patients. Government and private insurance plans are unbelievably cumbersome and complicated to work with and make it difficult to deliver appropriate care and receive timely, accurate reimbursement.

This doctor shoppers plan was just another straw that was breaking the medical camel's back. Compliance with government policies, risk of audits, electronic health record system mandates, the threat of Medicare and Medicaid reimbursement cuts, and private health insurance company precertifications, prior authorizations, and payment denials apparently aren't enough to chase physicians away from participation in risky programs. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.