Managed-Care Incentives Should Be Disclosed, Phys...( at substantial financial risk -- doct...),Health

at "substantial financial risk" -- doctors who could lose 25 percent or more of "maximum anticipated total payment." Such plans are required to ask patients about their satisfaction with quality of care and access to services and to report the results to the HCFA. Physician groups with more than 25,000 patients are exempt from these additional requirements.

Interpreting Incentives

Gallagher and co-authors have several concerns about the federal regulations. They point out that little is known about the effects of financial incentives on the quantity or quality of health care. "It is difficult to scrutinize care that has not taken place, and the technology to detect underutilization is not well-developed," Gallagher says.

The fact that health plans only need to disclose summary information is another problem, the authors say, because patients may not be able to determine which incentive, if any, applies to their doctor or group of doctors. Without medical knowledge, patients also may be unable to assess whether financial incentives are influencing their doctors' judgment. Consumer groups, such as Consumers Union or the American Association of Retired Persons, could play an important role in helping patients interpret information about incentives. However, these consumer groups currently do not have access to enough information about incentives to help patients determine whether a specific incentive is likely to pose a significant problem.

The authors recommend that HCFA use its market power to promote the development of better outcome measures. When awarding contracts, for example, it could favor health plans that monitor and reduce underutilization of services. HCFA also could give preference to health plans that survey patients to determine whether financial incentives create the perception of a conflict of interest between doctors and patients.

Meanwhile, the authors recommend broader disclosure so that interested patients -- even th
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Contact: Linda Sage
sage@medicine.wustl.edu
314-286-0119
Washington University in St. Louis
27-Jan-1999

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