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Health Serv Res. 2000 April; 35(1 Pt 2): 333–349.
PMCID: PMC1089105

Associations between primary care physician satisfaction and self-reported aspects of utilization management.

Abstract

OBJECTIVE: To evaluate the association between physician-reported utilization management (UM) techniques in capitated physician groups and physician satisfaction with capitated care. STUDY SETTING: 1,138 primary care physicians from 89 California capitated physician groups in 1995. STUDY DESIGN: Eighty percent of physicians (N = 910) responded to a mail survey regarding the UM policies in their groups and their satisfaction with the care they deliver. Physician-reported UM strategies measured included group-mandated preauthorization (number of referrals requiring preauthorization, referral denial rate, and referral turnaround time), group-provided explicit practice guidelines, and group-delivered educational programs regarding capitated care. We also measured two key dimensions of satisfaction with capitated care (multi-item scales): (1) satisfaction with capitated care autonomy and quality, and (2) satisfaction with administrative burden for capitated patients. EXTRACTION METHODS: We constructed two multivariate linear regression models to examine associations between physician-reported UM strategies and physician satisfaction, controlling for demographic and practice characteristics and adjusting for clustering. PRINCIPAL FINDINGS: Physician-reported denial rate and turnaround time were significantly negatively associated with capitated care satisfaction. Physicians who reported that their groups provided more guidelines were more satisfied on both dimensions, while physicians who reported that their groups sponsored more educational programs were more satisfied with administrative burden. The number of clinical decisions requiring preauthorization was not significantly associated with either dimension of satisfaction. CONCLUSIONS: Physicians who reported that their groups used UM methods that directly affected their autonomy (high denial rates and long turnaround times) were less satisfied with care for capitated patients. However, a preauthorization policy for referrals or tests was not, in and of itself, associated with satisfaction. Indirect control mechanisms such as guidelines and education were positively associated with satisfaction.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bodenheimer T. The American health care system--physicians and the changing medical marketplace. N Engl J Med. 1999 Feb 18;340(7):584–588. [PubMed]
  • DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, Kaplan S, Rogers WH. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993 Mar;12(2):93–102. [PubMed]
  • Donelan K, Blendon RJ, Lundberg GD, Calkins DR, Newhouse JP, Leape LL, Remler DK, Taylor H. The new medical marketplace: physicians' views. Health Aff (Millwood) 1997 Sep-Oct;16(5):139–148. [PubMed]
  • Emanuel EJ, Dubler NN. Preserving the physician-patient relationship in the era of managed care. JAMA. 1995 Jan 25;273(4):323–329. [PubMed]
  • Gaynor M, Haas-Wilson D. Change, consolidation, and competition in health care markets. J Econ Perspect. 1999 Winter;13(1):141–164. [PubMed]
  • Grumbach K, Selby JV, Damberg C, Bindman AB, Quesenberry C, Jr, Truman A, Uratsu C. Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists. JAMA. 1999 Jul 21;282(3):261–266. [PubMed]
  • Kerr EA, Hays RD, Mittman BS, Siu AL, Leake B, Brook RH. Primary care physicians' satisfaction with quality of care in California capitated medical groups. JAMA. 1997 Jul 23;278(4):308–312. [PubMed]
  • Kerr EA, Hays RD, Mitchinson A, Lee M, Siu AL. The influence of gatekeeping and utilization review on patient satisfaction. J Gen Intern Med. 1999 May;14(5):287–296. [PMC free article] [PubMed]
  • Kerr EA, Mittman BS, Hays RD, Leake B, Brook RH. Quality assurance in capitated physician groups. Where is the emphasis? JAMA. 1996 Oct 16;276(15):1236–1239. [PubMed]
  • Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH. Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Med. 1995 Oct 1;123(7):500–504. [PubMed]
  • Kletke PR, Emmons DW, Gillis KD. Current trends in physicians' practice arrangements. From owners to employees. JAMA. 1996 Aug 21;276(7):555–560. [PubMed]
  • Mechanic D, Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996 Jun 5;275(21):1693–1697. [PubMed]
  • Schlesinger MJ, Gray BH, Perreira KM. Medical professionalism under managed care: the pros and cons of utilization review. Health Aff (Millwood) 1997 Jan-Feb;16(1):106–124. [PubMed]
  • Sulmasy DP. Physicians, cost control, and ethics. Ann Intern Med. 1992 Jun 1;116(11):920–926. [PubMed]
  • Terry K. New survey results. Managed-care participation--and income--keep rising. Med Econ. 1996 Oct 14;73(19):196–208. [PubMed]
  • Wickizer TM. Controlling outpatient medical equipment costs through utilization management. Med Care. 1995 Apr;33(4):383–391. [PubMed]

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