Survey Finds MA Doctors ‘Hesitant’ On Payment Reform, Particularly Specialists

For the past 10 years, a random selection of Massachusetts doctors have been surveyed on how they’re feeling about certain aspects of their profession. This year, for the first time, they were asked about new payment models and health care delivery strategies.

More than 1,070 practicing physicians responded, and here, according the 2011 Massachusetts Medical Society Annual Physician Workforce Survey, is what they said:

On Payment Reform

Overall, doctors (not exactly the folks most likely to embrace radical change) had mixed views on global payments and accountable care organizations. “Hesitant to participate” is how their reaction is characterized in the press release. Specifically, the survey found:

Familiarity with global payments is high, with 57 percent of physicians saying they were familiar with the concept.

–Of all respondents, 42 percent said they were likely, and 58 percent said they were not likely to participate in a voluntary global payment system.

–Of those respondents who said they were familiar, 45 percent said they are likely to participate in a voluntary global payment system; 55 percent said they were not likely.

Primary care physicians (61.4%) are more likely to participate in a voluntary global payment system than specialists (32.2%).

On Accountable Care Organizations (ACOs)

–Familiarity with ACOs is high, with 58 percent of physicians saying they were familiar with ACOs.

–Of all respondents, 49 percent said they were likely, and 51 percent said they were not likely to participate in a voluntary ACO

–Of those who said they were familiar, 59 percent said they were likely to participate in a voluntary ACO, and 41 percent said they were not likely.

Primary care physicians (71.9%) were more likely to participate voluntarily in an ACO than specialists (50.2%).

This hesitancy to more fully embrace payment reform may not be based on ideology. According to a separate study by researchers at the Harvard School of Public Health, many doctors said they simply didn’t have the technology, resources or support to move their practices into an aco or global payment system. That study of 572 doctors found:

“Only 7 percent of all respondents said their practice has access to computer systems to manage clinical information, and only 29 percent said their group is ready to enter into a global payment contract.”

Other findings from the large survey include:

Doctor Shortages

Eight of 18 specialties are in critical or severe shortages: family medicine, internal medicine, general surgery, neurosurgery, dermatology, orthopedics, psychiatry, and urology.

–Family medicine and internal medicine (primary care) face shortages for the sixth consecutive year.

Malpractice Concerns

–45.8 percent of physicians said they have altered or limited the scope of their practice because of the fear of being sued.

On The U.S. Health Care System

–23% (versus 32% in 2010) preferred both public and private plans with a public buy-in option for businesses and individuals.

–15% (v. 17%) said keep the existing mix of public and private plans, but allow insurers to sell plans with limited benefits and high deductibles to keep premiums low.

17% (v.14%) preferred the current Affordable Care Act.

41% (v. 34%) preferred a single-payer national health care system.

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