U.S. Plans Stealth Survey on Access to Doctors
Monday, June 27, 2011
U.S. Plans Stealth Survey on Access to Doctors
By: Robert Pear, New York Times
WASHINGTON - Alarmed by a shortage of primary care doctors,
Obama administration officials are recruiting a team of "mystery
shoppers" to pose as patients, call doctors' offices and request
appointments to see how difficult it is for people to get care when
they need it.
The administration says the survey will address a "critical
public policy problem": the increasing shortage of primary care
doctors, including specialists in internal medicine and family
practice. It will also try to discover whether doctors are
accepting patients with private insurance while turning away those
in government health programs that pay lower reimbursement
rates.
Federal officials predict that more than 30 million Americans
will gain coverage under the health care law passed last year.
"These newly insured Americans will need to seek out new primary
care physicians, further exacerbating the already growing problem"
of a shortage of such physicians in the United States, the
Department of Health and Human Services said in a description of
the project prepared for the White House.
Plans for the survey have riled many doctors because the secret
shoppers will not identify themselves as working for the
government.
"I don't like the idea of the government snooping," said Dr.
Raymond Scalettar, an internist in Washington. "It's a pernicious
practice - Big Brother tactics, which should be opposed."
According to government documents obtained from Obama
administration officials, the mystery shoppers will call medical
practices and ask if doctors are accepting new patients and, if so,
how long the wait would be. The government is eager to know whether
doctors give different answers to callers depending on whether they
have public insurance, like Medicaid, or private insurance, like
Blue Cross and Blue Shield.
Dr. George J. Petruncio, a family doctor in Turnersville, N.J.,
said: "This is not a way to build trust in government. Why should I
trust someone who does not correctly identify himself?"
Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash.,
said: "If federal officials are worried about access to care, they
could help us. They don't have to spy on us."
Dr. Robert L. Hogue, a family physician in Brownwood, Tex.,
asked: "Is this a good use of tax money? Probably not. Everybody
with a brain knows we do not have enough doctors."
In response to the drumbeat of criticism, a federal health
official said doctors need not worry because the data would be kept
confidential. "Reports will present aggregate data, and individuals
will not be identified," said the official, who requested anonymity
to discuss the plan before its final approval by the White
House.
Christian J. Stenrud, a Health and Human Services spokesman,
said: "Access to primary care is a priority for the administration.
This study is an effort to better understand the problem and make
sure we are doing everything we can to support primary care
physicians, especially in communities where the need is
greatest."
The new health care law includes several provisions intended to
increase the supply of primary care doctors, and officials want to
be able to evaluate the effectiveness of those policies.
Federal officials said the initial survey would cost $347,370.
Dr. Hogue said the money could be better spent on the training or
reimbursement of primary care doctors. The White House defended the
survey, saying a similar technique had been used on a smaller scale
in President George W. Bush's administration.
Most doctors accept Medicare patients, who are 65 and older or
disabled. But many say they do not regard the government as a
reliable business partner because it has repeatedly threatened to
cut their Medicare fees. In many states, Medicaid, the program for
low-income people, pays so little that many doctors refuse to
accept Medicaid patients. This could become a more serious problem
in 2014, when the new health law will greatly expand eligibility
for Medicaid.
Access to care has been a concern in Massachusetts, which
provides coverage under a state program cited by many in Congress
as a model for President Obama's health care overhaul.
In a recent study, the Massachusetts Medical Society found that
53 percent of family physicians and 51 percent of internal medicine
physicians were not accepting new patients. When new patients could
get appointments, they faced long waits, averaging 36 days to see
family doctors and 48 days for internists.
In the mystery shopper survey, administration officials said, a
federal contractor will call the offices of 4,185 doctors - 465 in
each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New
Mexico, North Carolina, Tennessee, Texas and West Virginia. The
doctors will include pediatricians and
obstetrician-gynecologists.
The calls are to begin in a few months, with preliminary results
from the survey expected next spring. Each office will be called at
least twice - by a person who supposedly has private insurance and
by someone who supposedly has public insurance.
Federal officials provided this example of a script for a caller
in a managed care plan known as a preferred provider organization,
or P.P.O.:
Mystery shopper: "Hi, my name is Alexis Jackson, and I'm calling
to schedule the next available appointment with Dr. Michael Krane.
I am a new patient with a P.P.O. from Aetna. I just moved to the
area and don't yet have a primary doctor, but I need to be seen as
soon as possible."
Doctor's office: "What type of problem are you
experiencing?"
Mystery shopper: "I've had a cough for the last two weeks, and
now I'm running a fever. I've been coughing up thick greenish mucus
that has some blood in it, and I'm a little short of breath."
In separate interviews, several doctors said that patients with
those symptoms should immediately see a doctor because the symptoms
could indicate pneumonia, lung cancer or a blood clot in the
lungs.
Other mystery shoppers will try to schedule appointments for
routine care, like an annual checkup for an adult or a sports
physical for a high school athlete.
To make sure they are not detected, secret shoppers will hide
their telephone numbers by blocking caller ID information.
Eleven percent of the doctors will be called a third time. The
callers will identify themselves as calling "on behalf of the U.S.
Department of Health and Human Services." They will ask whether the
doctors accept private insurance, Medicaid or Medicare, and whether
they take "self-pay patients." The study will note any
discrepancies between those answers and the ones given to mystery
shoppers.
The administration has signed a contract with the National
Opinion Research Center at the University of Chicago to help
conduct the survey.
Jennifer Benz, a research scientist at the center, said one
purpose of the study was to determine whether the use of mystery
shoppers would be a feasible way to track access to primary care in
the future.
The government could survey consumers directly, but patients may
not accurately recall how long it took to get an appointment, and
their estimates could be colored by their satisfaction with the
doctor, researchers said.