May 2006

Physicians without managed-care contracts rises

After remaining stable since the mid-1990s, the proportion of U.S. medical doctors without any managed-care contracts rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study released by the Center for Studying Health System Change (HSC).

Compared with physicians with one or more managed-care contracts, physicians without managed-care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States, the study found.

Options for physicians who do not contract with managed care plans range from seeing only patients covered by insurance products that do not include provider networks (including fee-for-service Medicare), establishing cash-only practices, and serving managed care patients as an out-of-network provider who can balance bill patients for charges beyond insurer reimbursements for out-of-network providers.

Growth in the percentage of physicians without any managed care contracts may reflect fewer privately insured patients enrolled in health maintenance organizations (HMO) that do not pay for care received from out-of-network providers. At the same time, enrollment in plans that pay some cost of out-of-network care — preferred provider organizations (PPOs) and point of service (POS) plans — grew 13 percentage points between 2000 and 2005, according to the Kaiser Family Foundation. In 2005, more than three-quarters of people with employer health coverage were enrolled in a PPO or POS plan.

Based on HSC’s nationally representative Community Tracking Study Physician Survey, the study’s findings are detailed in a new HSC Tracking Report — “No Exodus: Physicians and Managed Care Networks” — available at www.hschange.com/CONTENT/838/.

The Center for Studying Health System Change, www.hschange.com

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