Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine

Feldman, Debra S.; Novack, Dennis H.; Gracely, Edward J.

doi:10.1001/archinte.158.15.1626

Cited by 120 publications

(78 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, because trust develops over time and because the pressures of managed care are particularly relevant for the "gatekeepers" of care (i.e., primary care physicians), most of the available literature has focused on primary care providers who often develop long-term relationships with their patients (5)(6)(7)10,(12)(13)(14)(15). Patients with rheumatic disease, however, also develop long-term relationships with their rheumatologist and may see their rheumatologist more often than their primary care physician.…”

Section: Introductionmentioning

confidence: 99%

Use of the trust in physician scale in patients with rheumatic disease: Psychometric properties and correlates of trust in the rheumatologist

Freburger

Callahan

Currey

et al. 2003

Arthritis & Rheumatism

106

111

View full text Add to dashboard Cite

Objectives. To assess the psychometric properties of the Trust in Physician Scale and to identify variables associated with patients' trust in their rheumatologist. Methods. Analyses of self reported data from 713 patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia. Study variables included the Trust in Physician Scale, a decision-making question, a medical skepticism measure, and demographic and health-related measures. Internal consistency and construct validity were assessed using correlational analyses and factor analysis. A regression analysis was conducted to identify factors associated with trust in the rheumatologist. Results. Internal consistency of the scale was high (Cronbach's alpha ‫؍‬ 0.87). Scale items also loaded on a single factor. Construct validity was supported by inverse correlations between higher trust scores and both skepticism and independent decision making. Decreased trust was associated with older age, minority status, higher education, diagnosis of fibromyalgia or osteoarthritis, and poorer health. Conclusion. The Trust in Physician Scale is appropriate for patients with rheumatic disease. Several patient characteristics appear to be associated with lower trust in the rheumatologist.

show abstract

Section: Introductionmentioning

confidence: 99%

Use of the trust in physician scale in patients with rheumatic disease: Psychometric properties and correlates of trust in the rheumatologist

Freburger

Callahan

Currey

et al. 2003

Arthritis & Rheumatism

106

111

View full text Add to dashboard Cite

show abstract

“…[1][2][3] In response to multiple pressures, physicians have reported changes in practice administration, billing, and coding of clinical diagnoses. 4,5 Some examples include documenting suicidal behavior, although the patient did not report this, to obtain an urgent psychiatric assessment; deliberate misdiagnosis of depression and substitution with another code; and overstating severity of symptoms to obtain managed care coverage for cardiac surgery. 5,6 Miscoding, gaming, and substitution with alternate diagnostic codes are methods that some physicians use to obtain patient services or additional reimbursement, or to attempt to minimize stigma of a diagnosis.…”

mentioning

confidence: 99%

Coding of Pediatric Behavioral and Mental Disorders

2002

View full text Add to dashboard Cite

ABSTRACT. Background. In response to changing reimbursement and other pressures in the health care environment, many physicians have reported the use of alternate coding to substitute for certain clinical diagnoses. However, very little information is available on how physicians who care for children approach diagnosis and coding dilemmas for behavioral and mental disorders, which often present unique additional challenges.Objective. Our study sought to describe the frequency of alternate coding, different approaches to coding, and attitudes toward diagnosis and coding practices by physician specialty.Methods. We conducted a mail survey of 1492 physicians-497 developmental/behavioral pediatricians (DBP), 500 pediatricians (PED), and 495 child and adolescent psychiatrists (PSY). The main outcomes were survey items on frequency of alternate coding (never, rarely, monthly, weekly, daily), use of different coding strategies (use of somatic symptoms, modifiers, and substitution with other terms), and attitudes on coding practices (Likert scales of agreement). We analyzed outcomes by physician specialty and demographics using Pearson's 2 and multivariate logistic regression.Results. Overall response rate was 62% (787 of 1269 eligible physicians). The majority of physicians had used an alternate code (DBP 83%, PED 68%, PSY 58%), and many respondents reported monthly-daily alternate coding (DBP 60%, PED 36%, PSY 27%). Physicians used multiple approaches to diagnosis and a variety of coding options, which varied by physician specialty. Financial issues were commonly cited reasons for alternate coding-both to obtain patient services and to receive physician reimbursement. However, challenges of diagnostic classification and coding subthreshold symptoms were cited as frequently as reimbursement issues. Stigmatization, confidentiality, and parental acceptance were mentioned, but reported less frequently. Very few practices and providers have organized administrative methods of alternate coding (26%) or receive feedback on denied claims (46%). Most physicians believe that alternate coding is justified in the present system; however, some physicians expressed concerns that these practices may contribute to stigmatization or lead to improper management decisions.Conclusions. Alternate coding is commonly reported; however, approaches to diagnostic coding vary by provider specialty. Reimbursement issues are important, but other challenges in diagnosis and classification hold special relevance to children with behavioral and mental disorders. There seems to be a great need to reconsider the separate goals and uses of clinical diagnosis and administrative coding. Additional study is needed to assess how reported coding practices may affect administrative data, patient care, and health care economics. Pediatrics 2002;110(1). URL: http://www.pediatrics.org/ cgi/content/full/110/1/e8; diagnosis, medical practice management, reimbursement, medical records, insurance claim reporting, mental health services.

show abstract

“…Two measures of gatekeeping were used to operationalize managed care: respondents' perceptions of whether their plan required them to select a PCP 1 and obtain authorization for specialty referrals from a PCP. 2 These items were coded as yes/no responses. They reflect managed care plan restrictiveness and have been shown to adversely affect the PPR for the general population.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3] Current changes in the delivery of medical care, particularly under managed care, may have profound effects on the PPR. Gatekeeping arrangements, a hallmark of health maintenance organizations, appear to undermine patients' trust that their primary care practitioners (PCPs) act on their behalf, particularly when referrals to specialty services are discouraged or denied.…”

mentioning

confidence: 99%

Vulnerability and the Patient–Practitioner Relationship: The Roles of Gatekeeping and Primary Care Performance

et al. 2003

View full text Add to dashboard Cite

Objectives. We examined whether patients’ perceptions of their relationships with primary care practitioners (PCPs) vary by vulnerability status and assessed the extent to which gatekeeping arrangements and primary care performance moderate potential disparities. Methods: We used the nationally representative 1996–1997 Community Tracking Study Household Survey as our data source. Results. Whites reported better patient–practitioner relationships than minorities. Requirements that patients select a PCP and obtain referral authorization neither reduced nor exacerbated racial disparities in the patient–practitioner relationship. On the other hand, access to and continuity with a PCP substantively reduced disparities, especially for the most vulnerable group. Conclusions. Enhancing primary care performance may reduce some of the barriers to care experienced by vulnerable populations, thereby improving patients’ relationships with their PCPs.

show abstract

Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine

Abstract: Many physicians surveyed believe managed care has significant negative effects on the physician-patient relationship, the ability to carry out ethical obligations, and on quality of patient care. These results have implications for health care system reform efforts.

Cited by 120 publications

References 50 publications

Use of the trust in physician scale in patients with rheumatic disease: Psychometric properties and correlates of trust in the rheumatologist

Use of the trust in physician scale in patients with rheumatic disease: Psychometric properties and correlates of trust in the rheumatologist

Coding of Pediatric Behavioral and Mental Disorders

Vulnerability and the Patient–Practitioner Relationship: The Roles of Gatekeeping and Primary Care Performance

Contact Info

Product

Resources

About