Health Care Providers and their “Boy who Cried Wolf” Problem

Remember that useful physician audit study that imploded last month? Maybe providers are wishing they hadn’t helped to kill it.

This week’s debt ceiling agreement includes some Medicare cuts. The Obama administration reassures the public that these cuts would only affect providers. Not surprisingly, many providers are unhappy. They suggest that reduced reimbursements will damage primary care or will reduce patient access to care. They might have a good point. They might also be ignored, because providers have a well-deserved “boy who cried wolf” problem. They deploy the same objections every time, whether changes in reimbursement are reasonable or not.

Wouldn’t it be great if providers could cite some credible unbiased studies to document how reduced reimbursement might reduce patients’ access to care? Oh yeah. There was such a study. Physicians helped to kill it.

In case you forgot…. About a month ago, the New York Times included a story with the scary headline “U.S. plans stealth survey on access to doctors.” As Pear described, the National Opinion Research Center here at the University of Chicago had signed a $347,000 contract with the Department of Health and Human Services to conduct audit studies of more than 4,000 doctors in nine states.

Paralleling the methodology of a recent New England Journal of Medicine study, NORC auditors would have called each medical practice twice to request appointments. Callers would follow an explicit script. In one of the calls, auditors would have reported that they have public insurance such as Medicaid. In the other call, auditors would have reported having private coverage. Some physicians would have also received a third call for an identified survey researcher, who would inquire about whether these providers accept different types of insurance.

By and large, medical providers hated this study.

“I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.” …

Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.”

Utah Senator Orrin Hatch criticized the study as “wasting taxpayer dollars to snoop into the care physicians are providing to their patients.”

Two days later, the White House placed the proposed study on “indefinite hold.” Official Washington quickly moved on.

From a political perspective, I understood why the administration pulled the plug. The big-brother optics were obvious. Physicians were not happy, in part because the profession would have been embarrassed by the likely findings: That many doctors avoid low-income patients with public insurance. The administration could ill-afford to irritate a medical profession with whom it is negotiating many issues in health reform.

On the merits, this study was quite sensible. The federal government spends some $800 billion every year for medical care. We should spend 0.00004 percent of this princely sum to learn what we are actually buying (or trying to buy) with this massive sum. Providers should show greater support for such efforts.

Right now, we are blinder than we need to be as we contemplate painful measures. Ironically enough, providers themselves have less help than they might in getting past their “boy who cried wolf” problem.

[Cross-posted at The Reality-Based Community]

Harold Pollack

Harold Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago.