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Obama Hires Mystery Shoppers to Spy on Doctors...What next?

 
 
Miller
 
Reply Tue 28 Jun, 2011 04:17 pm
June 26, 2011
U.S. Plans Stealth Survey on Access to DoctorsBy ROBERT PEAR
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.
NYTimes.com
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Type: Discussion • Score: 13 • Views: 4,704 • Replies: 76

 
roger
 
  3  
Reply Tue 28 Jun, 2011 04:44 pm
@Miller,
Miller wrote:

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.


Gee, I wonder what the answer will be. It's a problem, and I imagine his solution will be to require doctors to accept medicare and medicaid.
Cycloptichorn
 
  3  
Reply Tue 28 Jun, 2011 04:48 pm
@roger,
roger wrote:

Miller wrote:

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.


Gee, I wonder what the answer will be. It's a problem, and I imagine his solution will be to require doctors to accept medicare and medicaid.


Is this a bad thing?

Cycloptichorn
engineer
 
  10  
Reply Tue 28 Jun, 2011 06:22 pm
And how is it spying? Sounds more like market research. I guess if a pollster calls you and asks if you are going to vote in the next election, that is spying too. Heaven forbid policy decisions are actually based on data.
0 Replies
 
Foofie
 
  1  
Reply Tue 28 Jun, 2011 06:56 pm
Will this ultimately result in new doctors being "assigned" to a specific geographical region, based on survey results of where doctors are too sparse?
georgeob1
 
  1  
Reply Tue 28 Jun, 2011 07:23 pm
@Cycloptichorn,
Cycloptichorn wrote:

Is this a bad thing?

Cycloptichorn


Only if individual freedom is important to you.
engineer
 
  9  
Reply Tue 28 Jun, 2011 07:34 pm
@Foofie,
We already know that rural areas are under-served. Understanding the magnitude of the problem will not allow the government to start demanding private citizens move to different areas of the country. Are we really at the point where when the government attempts to actually understand a problem instead of just issuing knee jerk reactions to the latest cable news story that they are accused of "spying" or taking away rights?
RABEL222
 
  0  
Reply Tue 28 Jun, 2011 11:14 pm
@engineer,
Yes. To the Nazi conseratives of this country anything the dems do is considered unamerican. I am sure as hell glad that I wont be around long enough to see the government the conseratives concoct but feel very sorry for my childern.
0 Replies
 
Mame
 
  1  
Reply Wed 29 Jun, 2011 06:34 am
@Foofie,
I don't see anything wrong with that. If one area is over-subscribed and another under-subscribed, they should go where they can get a billing number and hospital privileges.

We're all too spoiled - we want what we want and we want it now. Whatever happened to saving up for things and moving to where the work is? Many people have to move to where the work is and I see no difference with doctors.

In BC, medical students are heavily subsidized and I feel they owe their country something for their education. Hospitals are able to limit the number of doctors getting privileges and the provincial governments can and do restrict billing areas.

Most new foreign doctors are assigned to rural areas for a certain term, after which, they can apply to work elsewhere.

Life's tough, eh? They're making a decent living and working their trade but still that's not enough. Oh, cry me a river.
0 Replies
 
ehBeth
 
  3  
Reply Wed 29 Jun, 2011 06:50 am
@Miller,
Miller wrote:
WASHINGTON — Alarmed by a shortage of primary care doctors,


ok - they already know there are not enough primary care doctors (doh, most people have known that for at least 15 - 20 years) - do something at the front end - determine what services doctors are really needed for - allow licencing for paramedical professionals for services that don't really require a doctor etc etc

if there are enough doctors out there, the market will take care of itself in terms of location and who they will provide treatment to

I don't have a problem with the "mystery shoppers" concept in general - most good businesses have a similar program in place - but it seems to be throwing money at the wrong end of the problem.

Spend the money on figuring out how to quickly/effectively qualify docs with out of country training, set up more nurse practitioner programs.
Mame
 
  1  
Reply Wed 29 Jun, 2011 07:03 am
@ehBeth,
I've often thought that many issues people see the doctor about can be handled by a nurse practitioner or even a nurse. I have a lot of gripes about our system, actually, even though it's not the worst on the planet. I had to get a fungal foot ointment after a trip to Mexico and had to see the doctor to get a prescription for it. Why the hell is that not OTC??? Ditto with burn creams. What a waste of time and money.

Family doctors seem only to triage, document your health, and refer to specialists these days. My family doctor removed a cyst from my hand when I was 12 yet the other day my sister went to my doctor to have a lump diagnosed and dealt with and he referred her to a specialist of some sort to have it removed. He books a patient every 15 minutes so there's no time to do much. He bills at between $44 and $80 per visit. Don't know what his rent and other costs are, but he pays his receptionist $15/hr and office manager $17. And they all seem to charge now for filling out forms, even if they're done when you're in there. Why would they charge for that when they're already billing for the appointment and you only went in to get the form done? Not only that, but some doctors have a rule where they will only deal with ONE of your issues - you have to have a separate appointment for each - even if they could all be answered in your appointment time. That's ridiculous.

I like my doctor very much. I don't know if he charges for forms, but he will answer all your questions in one appointment and doesn't appear to rush you.

By the way, for all you menopausal women out there, I heard about Estroven and since I've been taking it, my hot flashes are now infrequent, last less long, and are less severe. It's wonderful!
gungasnake
 
  1  
Reply Wed 29 Jun, 2011 07:08 am
@Miller,
This is after the most major effort ever undertaken to drive people out of the medical profession i.e. the dufe wants to investigate the problem HE just created.
ehBeth
 
  3  
Reply Wed 29 Jun, 2011 07:14 am
@gungasnake,
gungasnake wrote:
HE just created.


that's just goofy.

The problem has been around for close to two decades that I'm aware of - could be longer, but I wasn't paying much attention to the American medical system before that.

The problem wasn't "just created".

Goofiness.
0 Replies
 
georgeob1
 
  2  
Reply Wed 29 Jun, 2011 08:56 am
The underlying truth here is that the government is seeking this information because they have good reason to believe doctors are limiting the number of Medicare and Medicaid patients they treat because of the billing hassles and arcane regulations involved and more importantly, because the rates for service set by the government are deemed to be too low. In typical governmen t fashion they are eager to believe it is not their stupid rules and policies that are at fault: instead it is the doctors and their patients. The fact is the government does not have the constitutional or legislative authority to set the rates doctors charge for their services. Government can set the rates it will pay for services funded by government, but that does not compel providers to work for the rates they establish.

A good story of how freedom is lost with top down government "solutions" to problems. Freedom is better.
Cycloptichorn
 
  2  
Reply Wed 29 Jun, 2011 09:17 am
@georgeob1,
georgeob1 wrote:

Cycloptichorn wrote:

Is this a bad thing?

Cycloptichorn


Only if individual freedom is important to you.


I generally don't find hyperoblic one-liners to be convincing. There's no contradiction between individual freedom and what the HHS dept. is doing.

Cycloptichorn
0 Replies
 
ehBeth
 
  2  
Reply Wed 29 Jun, 2011 09:41 am
@georgeob1,
georgeob1 wrote:
more importantly, because the rates for service set by the government are deemed to be too low.


government set rates in the U.S. are still high for the type/quality of medical service provided. definitely a rip-off to get medical tx in the U.S.

there's more than one reason we try to get people back here asap if they're sick/injured in the U.S. Quality and value of service.

Even the private clinics here charge less.
georgeob1
 
  1  
Reply Wed 29 Jun, 2011 04:14 pm
@ehBeth,
It is simply a readily observable fact that many doctors here won't take more than a few Medicare or Medicaid patients. In many large urban areas it is difficult for such a patient to find a doctor willing to care for them, If the rates are indeed too high as you say, why would they do this?
Butrflynet
 
  2  
Reply Wed 29 Jun, 2011 04:24 pm
Most of the information claimed to be "spying" on doctors is already available on many insurance and physician provider websites.

For instance, with Blue Cross/Blue Shield, I check off a few boxes about where I live, which coverage plan I have, what type of medical complaint I have and whether or not I'm a new patient. The website then spits out a list of doctors within my parameters that are accepting new patients and gives their contact info. If I want to inquire about a specific doctor, I fill in the info and it tells me whether or not the doctor is accepting new patients of any flavor.

The better question might be what is it that some doctors are attempting to hide by not disclosing to the public whether or not they accept new patients and new medicare/medicaid patients?
roger
 
  1  
Reply Wed 29 Jun, 2011 04:55 pm
@Butrflynet,
I don't think they are attempting to hide anything. Call and ask and I bet they will give you the answer. They are probably not advertising that they do or do not accept medicare patients. Great opportunity for a new doctor's practice. Run an ad specifying they do accept medicare assignments. In this town, they would be swamped, cuz none of them are currently accepting new medicare patients.

I did look into blue cross/blue shield for some kind of perferred provider plan. There are two docs that are in the plan. They share an office back behind a little shopping center. One of them is unofficially retired.
0 Replies
 
georgeob1
 
  2  
Reply Wed 29 Jun, 2011 06:13 pm
@Butrflynet,
Butrflynet wrote:

The better question might be what is it that some doctors are attempting to hide by not disclosing to the public whether or not they accept new patients and new medicare/medicaid patients?

I doubt that many are trying to hide it at all. All it takes is a phone call to see if they are accepting new patients. Indeed that is what the government is doing. Doctors are independent professionsla and have every right to do as they choose.
0 Replies
 
 

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