When Todd Warren initiated a survey regarding the perceptions of managed care through the eyes of Mississippi physicians in 1998, managed care had cast fear throughout the medical community. Many respondents expressed concerns about financial strain and the loss of autonomy, power, and freedom in the managed care “takeover.”

“I really didn’t know what I was getting into, especially after receiving 220 responses to the 514 surveys I mailed,” said Warren, executive director of Medical Practice Solutions in Jackson.

The results were eye-opening. At the time of the survey, Mississippi hadn’t experienced the full effects of managed care.

“We lived in a managed care society populated with PPOs, PHOs, and other alphabet soup organizations,” he explained. “However, the east and west coasts had full-blown managed care and in some cases in the form of capitation. This was the movement Mississippi physicians feared most.”

Flash forward 13 years, and the landscape of healthcare has changed dramatically with the advent of healthcare reform, prompting Warren to undertake a similar survey.

“It’s safe to say that whether it’s managed care, healthcare reform, or any other term used to describe the changing face of healthcare, there will always be some movement we all have to adjust to,” said Warren.

Before rolling out the new survey, Warren reviewed 1998 results. One in three respondents was a primary care physician; 23 percent represented primary care sub-specialties, and 40 percent were surgical specialty physicians.

Concerning strategy, two of three respondents believed managed care would have an adverse impact on their long-term viability and growth. This response varied by group, with 48 percent of primary care physicians believing that managed care would adversely affect their growth, compared to 68 percent of primary care sub-specialists and 75 percent of the surgical specialists. These differences, Warren explained, indicated that primary care physicians believed their practices wouldn’t be affected as much since they would be considered the “gatekeeper” in a closed model managed care delivery system. Surgical and primary care sub-specialists predicted that their growth could be affected with restricted access and forced utilization controls.

“Mississippi physicians were proactively planning,” said Warren. “Nearly 75 percent of the physicians surveyed either ‘moderately agreed’ or ‘strongly agreed’ that their survival strategy was growth. With no difference between the three groups of physicians, the common reasons expressed for merging or consolidating were increased bargaining power/clout, reduction of expenses through economies of scale, capability of offering more services, and increased patient referral base. Other growth reasons included recruiting additional physicians, opening satellite offices, and offering new services.”

Regarding hospital relationships, three of four respondents believed their relationship with a hospital was “moderately” to “extremely important.” 

“This thought was constant among all groups—81 percent of all primary care physicians, 71 percent of primary care sub-specialists, and 73 percent of surgical specialists,” he said.

Reasons for the importance of a relationship with the hospital covered many areas: collaborative marketing strategy opportunities, availability of more services/procedures, access to capital, and the possible development of a vertically integrated system.

“I found that 35 percent of the surveyed physicians were either ‘not aware’ or only ‘somewhat aware’ of the services provided by local hospitals,” noted Warren. “This seems to indicate that local hospitals hadn’t formulated their plans of services or hadn’t completely introduced them.”

According to the survey, the top five services desired by physicians were revenue enhancing mechanisms (56 percent), strategic planning (46 percent), managed care review (42 percent), satellite office development (33 percent), and coding assistance (32 percent). The level of importance was consistent by group. Based on this feedback, Warren said, it was apparent that all physicians wanted to find ways to enhance or maintain their revenue and prepare their practices through strategic planning with the influence of managed care as the basis for their future.

Concerning financial impact, the survey showed that physicians clearly regarded managed care as a severe threat to their earnings, with 91 percent of all physicians responding that managed care would either have a “negative effect” or “somewhat negative” effect on their earnings.

“The financial impact response only slightly varied among groups as 96 percent of surgical specialists felt managed care would hurt their earnings, compared to 86 percent of primary care sub-specialists and 83 percent of primary care physicians,” Warren pointed out.

With the perception of utilization constraints and non-covered services, 88 percent of all physicians believed managed care would negatively impact patient outcomes. This response varied by physician groups—82 percent primary care, 98 percent primary care sub-specialists, and 86 percent surgical specialists. 

Also, according to nearly 70 percent of respondents, capitation was predicted to arrive in two to five years—a timetable constant between groups. However, if capitation didn’t arrive within that time frame, 21 percent predicted it would arrive in five to 10 years—also representing a timetable constant between groups. “We haven’t experienced capitation yet,” said Warren, “largely in part to the proactive stances from Mississippi physicians and healthcare executives.”

The managed care threat appeared to be more menace than savior in the eyes of local physicians. According to the survey, 66 percent were either “very concerned” or “extremely concerned” about managed care in the future, with very little variance between physician groups. However, each group expressed the same general concerns, including interference with the doctor/patient relationship, intrusion of a “middle-man” to garnish profits, decreased reimbursement, patient’s limited choice of providers, feared decline in quality of medicine, potential to lower the quality of people entering medical school, and loss of control/autonomy.

“Despite the above-mentioned concerns, many physicians shared the same basic philosophy, best stated by a local cardiovascular surgeon: ‘Obviously, managed care may well have a major impact on medicine in general in Mississippi and in my practice in particular. However, I feel I will still make a good living and be able to continue to enjoy the gratifying aspects of the practice. I wouldn’t trade professions or specialty with anyone,’” said Warren.

Physicians interested in participating in the 2011 survey may contact Warren at TWarren@MPSBilling.com.

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