MANAGED CARE October 2009. ©MediMedia USA
Despite anecdotal reports to the contrary, the great majority — 87.6 percent — of physicians have contracts with managed care organizations. A new report from the Center for Studying Health Systems Change says that in fact, 70 percent of physicians had contracts with five or more managed care plans.
How does this affect a physician’s income? Compared with high-income physicians, a larger proportion of low-income physicians have no contracts.
Physicians without managed care contracts were more likely to have been in practice for more than 20 years, to work fewer than 40 hours per week, and to work in solo or duo practices. They were also more likely to practice in the West.
Physicians who are not board-certified are much more likely not to have managed care contracts, and “while the discussion is often about doctors not willing to contract with managed care plans, there are managed care plans that don’t want to contract with certain physicians because they lack board certification, which is a fairly common credentialing threshold for managed care plans,” says Alwyn Cassil, a spokeswoman for CSHSC and one of the study’s authors.
Options for physicians without managed care contracts range from seeing only patients covered by insurance products that do not include provider networks (such as fee-for-service Medicare) and accepting only cash for services and serving managed care patients as an out-of-network provider who can bill patients for charges beyond insurer allowances for out-of-network care.
Psychiatrists are the least likely specialists to have contracts with managed care — about 1 in 3 did not. The report suggests that this might have to do with low payment rates and a high degree of utilization management by health plans and managed behavioral health companies.
In contrast, pediatricians are very likely to have contracts with managed care — only 4.8 percent do not — in part because Medicaid managed care plans are a significant source of coverage for children.
Physicians with no managed care contracts
Source: Center for Studying Health System Change. Data Bulletin: A Snapshot of U.S. Physicians. September 2009.