Class 9 – PROVIDER’S PERSPECTIVE
The Provider’s perspective regarding managed care depends on which provider one talks to. Basically, if one were to talk to five providers, one most likely would get six varying opinions. Even the term “provider” may be resented by various providers because the term is so overly broad.
As far as what is the right answer in how to deal with the many issues managed care has brought up, there may not be a single right answer. For example, all kinds of variables can effect the answer to this question, such as, type of practice (primary care physician, specialist, hospital, nurse practitioner, hospitalist, etc.); rural versus urban; managed care penetration in the area and many more factors.
Some providers are active in policy-making on a state and national level. Provider’s may be participating in or leading their professional association’s lobbying efforts to pass or revise or create certain laws or regulations.
Some providers are looking at unions as the answer to compete against HMOs. The thinking here is that there is power in numbers, that the stronger the unified front, the stronger the negotiation power.
Some physicians are going back to a fee-for-service practice only and setting up NO-HMO type of practices in which they are paid for services rendered at the time services are rendered.
Accordingly, providers in general. are looking at an assortment of options to deal with the managed care issues, including: litigation against MCO’s, new legislation, unions, revamping their own practices or businesses, etc.
Further, other issues effecting providers includes: financial issues, mergers, acquisitions, dissolving relationships between physicians and hospitals in which such physician’s practices were acquired by hospitals, choice options of their patients to select providers that the patient’s employer healthplan has arrangements with, and the growing trend of patient’s becoming more educated by the internet.
Consider the article by Mark Sculpher, “Evaluating the Cost-Effectiveness of Interventions Designed to Increase the Utilization of Evidence-Based Guidelines,” Family Practice (Oxford University Press, 2000) that frequently, treatment decisions by clinicians do not reflect the findings of research evidence. “For example, the least effective drug for the management of menorrhagia, on the basis of a meta-analysis of randomized trials, was found to be the drug prescribed most frequently for the condition in a sample of general practices.” Techniques used to increase practitioner’s use of “good practice” within published evidence-based guidelines include education programs, sessions from opinion leaders and audit with feedback. Because there is an increasing use of interventions to change professional service and most research in this regard has focused on how to evaluate effectiveness and cost-effectiveness, this article, published in England, looks at various methodological issues regarding appropriate research design for evaluations of implementation interventions.
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