Challenges in Physician-Patient Relationships in Managed Care
Introduction
The United States healthcare system has been controlled by managed care organizations for more than 25 years. The purpose of managed care was to restrain the rising cost of healthcare while maintaining high levels of quality care. The rules and regulations created by managed care organizations has cause some significant issues within the physician practices. A positive physician-patient relationship is essential to receiving good healthcare. Managed care has the potential to undermine that relationship with its rules and regulations. Changing physicians, time constraints, and continuity of care are three very critical issues that can negatively affect quality …show more content…
People like to stay with physicians they are comfortable with and believe have the knowledge to care for them. However, managed care business can make it difficult for that relationship to continue. Patients may be forced to change providers because of network changes (physicians are dropped or leave the network) or because the insurance plan changes provider networks. If a person has an established physician that does not fall into their plan; they have to get a new physician or pay the cost out-of-pocket. This can be a huge inconvenience and financial burden to a patient. Some managed care organizations do not provide certain health care services within their networks, i.e. mental health or pain management. Plans will allow for patients to seek services out of network to deal with ailments, cost varies. The usage of PPOs has provided a way for people to maintain their primary care physician (PCP) outside of networks. Patients surveyed a 2003 study showed that continuity of care is very important but the majority were unwilling to spend additional time or money to maintain the relationship with their PCP. Patients with chronic diseases and older patients were willing to do more in order to keep their current PCP (Pereira and Pearson, 2003). Patient continuity of care could be drastically affected if medical history or record are not accessible to physicians. With electronic medical records …show more content…
Managed care has been known to use incentives and restrictions on tests and procedures in an attempt to influence physician decision making and limit costs. Guidelines for care are usually distributed by professional organizations, such as the American Medical Association, for the physician to follow in treating patients. Problems arise when the managed care guidelines do not match what the physician feels is needed for their patient. Having to receive prior approval for testing could prolong diagnoses in patients and lead to frustration is the process (Feldman, Novak and Gracely, 1998). This is when the physician must serve as an advocate for the patient if they feel a line of testing or treatment is necessary. There are other issues that can damage the relationship—network changes. The PCP is placed in a difficult position when the network makes changes and they have to suggest visiting new physicians. The PCPs want their patients to continue be trusting of them after recommending changes. Disagreements between the physician and patient can have significant consequences such as distrust, changing physicians, and legal action. Patients question whether physicians are truly making decisions based on the patient's best interest or are influenced by outside
Introduction
The United States healthcare system has been controlled by managed care organizations for more than 25 years. The purpose of managed care was to restrain the rising cost of healthcare while maintaining high levels of quality care. The rules and regulations created by managed care organizations has cause some significant issues within the physician practices. A positive physician-patient relationship is essential to receiving good healthcare. Managed care has the potential to undermine that relationship with its rules and regulations. Changing physicians, time constraints, and continuity of care are three very critical issues that can negatively affect quality …show more content…
People like to stay with physicians they are comfortable with and believe have the knowledge to care for them. However, managed care business can make it difficult for that relationship to continue. Patients may be forced to change providers because of network changes (physicians are dropped or leave the network) or because the insurance plan changes provider networks. If a person has an established physician that does not fall into their plan; they have to get a new physician or pay the cost out-of-pocket. This can be a huge inconvenience and financial burden to a patient. Some managed care organizations do not provide certain health care services within their networks, i.e. mental health or pain management. Plans will allow for patients to seek services out of network to deal with ailments, cost varies. The usage of PPOs has provided a way for people to maintain their primary care physician (PCP) outside of networks. Patients surveyed a 2003 study showed that continuity of care is very important but the majority were unwilling to spend additional time or money to maintain the relationship with their PCP. Patients with chronic diseases and older patients were willing to do more in order to keep their current PCP (Pereira and Pearson, 2003). Patient continuity of care could be drastically affected if medical history or record are not accessible to physicians. With electronic medical records …show more content…
Managed care has been known to use incentives and restrictions on tests and procedures in an attempt to influence physician decision making and limit costs. Guidelines for care are usually distributed by professional organizations, such as the American Medical Association, for the physician to follow in treating patients. Problems arise when the managed care guidelines do not match what the physician feels is needed for their patient. Having to receive prior approval for testing could prolong diagnoses in patients and lead to frustration is the process (Feldman, Novak and Gracely, 1998). This is when the physician must serve as an advocate for the patient if they feel a line of testing or treatment is necessary. There are other issues that can damage the relationship—network changes. The PCP is placed in a difficult position when the network makes changes and they have to suggest visiting new physicians. The PCPs want their patients to continue be trusting of them after recommending changes. Disagreements between the physician and patient can have significant consequences such as distrust, changing physicians, and legal action. Patients question whether physicians are truly making decisions based on the patient's best interest or are influenced by outside