DEFECTING DOCTORS: More M.D.s Saying No To Managed Care
Citing administrative headaches and low reimbursement rates, doctors are "quietly starting to fight back" by dropping out of managed care or whittling down the number of plans they accept. A story on the front page of Sunday's New York Times took a look at what it termed the "rebellion in white," noting that while there is no evidence of a mass exodus, physicians with more affluent patients willing to foot the bill for services are leading the "revolt." Although 92% of physicians in New York contracted with HMOs last year, the number scaling back or withdrawing altogether this year is "startling." Ten percent of physicians associated with New York Presbyterian Hospital have pulled out of managed care over the past three months, and 50% have scaled down the number of health plans they accept. "There is no question that a growing number of doctors are disassociating themselves from managed care," said Dr. Charles Aswad, executive vice president of the Medical Society of the State of New York. The Times reports that while doctors around the country are growing increasingly frustrated with managed care, New York "is particularly interesting" because the system "rolled into the region at a breakneck speed." Aswad explained, "California had an evolution toward managed care, and we have had a revolution."
'Caste' System Of Care?
The movement away from managed care sparks "difficult questions" about doctors' salaries and whether dropping out of managed care spawns "the caste system of care that [HMOs] were meant to eliminate by providing preventive care and a variety of services." Doctors with more diverse patient populations recognize that only wealthier patients are likely to have insurance plans allowing them to choose out-of-network physicians for lower reimbursement rates. And the Times predicts that as a strong economy prompts more employers to allow employees to choose out-of-network doctors, doctors may grow ever more likely to pull out of HMOs. "I think we are moving toward a two-tiered or three-tiered structure of health care," said Michael Lichman of Willis Corroon of New York. Dr. Barry Chaiken of the Association of Independent Physicians in New York said, "As managed care comes in and insists on fee discounts of 30% or more, physicians have to change their practice to survive." But some protest that physicians complaints are unfounded. Uwe Reinhardt, a health economist at Princeton University, said, "If doctors say that quality will fall as reimbursements fall, they are insulting themselves. The truth of the matter is that when a group of laborers are in surplus, wages fall. They are the only group that is unwilling to accept that" (Steinhauer, 1/10).