Managed Health Care Links Doctors' Pay to Profit, Studies Say

Article excerpt

Physicians face increasing conflicts with their independence, incomes and ethics under managed care arrangements, according to new surveys published last week in the New England Journal of Medicine.

One study of the payment and hiring arrangements of 108 managed care plans found that most health maintenance organizations adjust payments to doctors through some performance-based incentive.

Fifty percent of the HMOs using salaried staff doctors and 74 percent of those contracting with individual or group practices adjusted payments to primary care physicians according to how much health care their patients received or how much they cost the organization.

More than half of all the HMOs also shared some of the financial risk of treating patients with medical specialists, says the report, prepared over two years by researchers led by Marsha Gold of Mathematica Policy Research in Washington.

In an accompanying editorial in the journal, Drs. Steffie Woolhandler and David Himmelstein wrote: "For a growing number of physicians, income is tethered to conduct that furthers corporate profitability."

Gold and her colleagues argue that the financial incentives for controlling costs are much more widespread among all types of HMOs and even looser-knit Preferred Provider Organizations than many policy makers and analysts, such as the Congressional Budget Office, have acknowledged.

"Common arrangements between managed care plan and physicians appear to result in less independence and less control over income and practice for physicians," the researchers said.

Doctors' independence in the managed care environment was further challenged Wednesday as the Pew Health Professions Commission called for an end to professional discipline arrangements that allow only doctors to judge the competency of other doctors.

Given that an array of nurses, physician assistants and others are more involved in providing patient care under managed care, it is appropriate to also have those people, along with consumers, take part in proceedings "to determine whether individual physicians are providing satisfactory care to patients," said the commission, which is chaired by former Colorado Gov. …

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