Physician-Patient Relationships And Managed Care

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

This article scrutinized the amount of managed care contracts and how they correlated to the quantity of patient care hours a physician reports. Also surveyed was the percentage of hours reported by a physician for caring patients outside the practice. An alternative for administrative time was the observations of having sufficient patient time, career gratification, and revenue generated from the practice.

A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo.

Depending on the illness and chronic conditions that the baby boomer generation will have, health care costs will rise to receive these services. The top 5 chronic conditions are hypertension, high cholesterol, diabetes, arthritis and obesity. It is the perception that gatekeeping reduces health care costs in the United States and it is a very effective strategy that exists today in most organizations. A dedicated primary care physician will take the time to spend with their patients to review their concerns and go over their basic preliminary findings such as blood pressure, weigh and personal issues as an attempt to build a relationship. Patients' satisfaction with and trust in their doctors will remain high only if the public believes the trusts are acting on their behalf, rather than making decisions in their own financial interests. In the United States, some of the harshest criticism of gatekeeping has resulted from the public's perception that medical decision making was unduly influenced by financial considerations (Forrest, 2003). Over 37 million baby boomers will experience having to manage more than one chronic condition by 2030 resulting in an annual cost of $13,000 annually (“American Hospital Association”, 2007). The forecasted costs for health care from a national perspective were $2579 in 2003 and will continue to rise 20 percent by 2030 (Martini,

“Managed care embodies an effort by employers, the insurance industry, and some elements of the medical profession to establish priorities and decide who gets what from the health care system.” (JAMA.2001; pg. 285:2622-2628). Manage Care is part of the Health Care system since 1973 is known as the system that finances and delivers health care to individuals enrolled under their plans. Manage care is intended to reduce the unnecessary health care cost in America through a variety of mechanism that includes medical necessity review programs, economic incentives for physicians, beneficiary cost sharing, control of

In addition to the challenges of the primary care physician shortage, the shortage will also have a great impact on health care organizations from a business perspective. The shortage will have a great effect because physicians are revenue makers for healthcare organizations. The care primary care physicians provide translates into billable services that make up the organization’s income. It is reported that the average physician generates approximately $1.4 million in income for a healthcare organization (Amirault, 2014). Therefore, organizations operating with less primary care physicians could experience significant revenue loss. For example, if a health care organization is short a single primary care physician it could mean longer appointment waiting times for patients. This could result in patients choosing a different organization for their medical care and the health care organization will lose money. The organization will be affected in other ways as well because fewer primary care physicians mean lower patient satisfaction and quality of care. From a business perspective, the shortage of primary care physicians will

The expanded health insurance coverage via the Affordable Care act is having a major effect on managed care hospitals in many avenues. These effects are impacted via the increase in demand for care, the increase of patient revenues, as well as a lower uncompensated care especially for the uninsured. Not surprisingly, the constraints as well as the controls that are being imposed by the managed care have lead to an outrage by the doctors and their patients. Managed care in the United States finds itself under attack from every side. As far as the managed care organizations are concerned, administrators are unease regarding the profitability or the surplus for reinvestment and even the consumers are also worried about the possible closure of hospitals (Goodson, 2010). Managed Care Organizations have been forced to reduce hospital utilization even though there have also been a few facility closures.

Managed care reduces cost by keeping a pool of doctors and specialist to a minimum, and at the same time keeping the volume of patients high. This often means that a patient may not receive the same amount of attention and care as they should, or were accustomed to. Consumers have long grumbled that HMO's have done too much too keep health costs down by stinting on patient care.(1).

Kleiner, B. H. (2012) Gives insight into conducted research to show how research of managed care has increasingly become a leading development in regards to the finances in managed

Managed care integrates the delivery of health care and financing of health care. In managed care, insurance companies controls the cost, quality, and access of medical care to beneficiaries by limiting the reimbursement levels paid to providers,, by reducing utilization, or both (Beik, 2014, p. 116). There are different types of managed care. Some of the most common types of managed care are Preferred Provider Organization (PPO) and Health Maintenance Organizations. Managed care programs uses different interventions such as economic incentives for doctors and patients, increased cost sharing, controls on inpatient admission and length of stays, and so forth (Deom, Agoritsas, Bovier, & Perneger, 2010, p. 1). On the other hand, managed care tools such as gate keeping, health care networks, second opinion requirement, and pre approval requirement for expensive treatments or hospitalization has changed healthcare delivery on both the macro and micro levels. On the micro level, it greatly impacts the quality of care, cost, autonomy, and relations with patients. According to the research study, managed care greatly affects physicians. It reduces career satisfaction through its impact on doctors’ autonomy and the pressure caused by managed care may affect the doctor’s ability to provide high quality of medical care. (Deom, Agoritsas, Bovier, & Perneger, 2010, p. 7). Like for example, managed care contracting has a positive and negative impact on physicians and patients. The

For example, if the patient has active insurance than the physician understands that they will get compensated if the patient is seen. If the patient does not have insurance, most likely the patient will not been seen because the doctor will not be getting reimbursed or paid for that visit. Some hospitals have free-care programs where patients without insurance can receive free healthcare, but the hospitals and providers are not getting paid, which can hinder the stakeholders (physician). Therefore, if a patient has insurance, the doctor or healthcare provider is being benefitted. On the other hand, a factor that burdens stakeholders is the fact that U.S. health insurance plans are highly variable, and even the best plans do not cover all necessary care or provide first-dollar coverage (Scheetz, 2015). Therefore, either the patients are not receiving good quality of care or the doctors can perform the care, but they will not get reimbursed. Also since the Affordable Care Act (ACA) was enacted, more patients are being seen, which causes the physicians to receive a lot less money due to a lower fee

Would you rather have a physician who is more focused on paperwork or one who is more focused on making you better? In 2010, the United States government passed a federal bill called the Patient Protection and Affordable Care Act, which allows lower income people to buy insurance and expands the eligibility to apply for Medicaid. As a result of these changes made in health care, doctors are having to deal with more paperwork, making it more difficult to provide their patients with the care that they need. This debate has become an increasingly hot topic due to the fact that almost everyone is involved with healthcare in one way or another. Doctors, patients, nurses, administrators, and medical students are just a few groups of people that

Initially, physicians as a whole were not excited about the reform exhibited by the managed care systems (Bereson 1991). In the article, Physician

Managed care’s tremendous impact on medicine has focused on preventive health care, introduced outcomes measurement, evidence based medicine, utilization controls, and cost accountability to deliver high quality healthcare. At the same time, managed care has increased administrative overhead for providers, restricted vendor choices, and occasionally interfered with treatment protocols creating new problems in the healthcare setting. Virk (2007) suggests that managed care has become the backbone of the U.S. healthcare system and with the currently rising healthcare costs, critics have are again questioning the effectiveness of the managed care model. The decline of managed care in the United States appears at its highest point of acceptance as managed care plans competing in the healthcare market adopted characteristics of traditional insurance (Lagoe, Aspling, & Westert, 2005). As profitability became a tenet of managed care plans, premiums were increased passing a higher proportion of healthcare expenses to consumers. Managed care plans started catering more to consumer preferences in order to expand market share which decreased continuity of care and regulation of utilization controls, making managed care plans align more closely indemnity plans and preferred provider

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.