Six out of 10 HMOs are measuring enrollee satisfaction with their plan physicians. And, according to a recent study, the results are being used not only to gauge patient perceptions of their care but also to determine physician compensation.
The study of 200 HMO medical directors was conducted early this year by National Research Corp., a Lincoln, Neb.-based market research firm. The HMOs surveyed are representative of health plans nationally by size and model type.
NRC's study of HMO medical directors found that formal evaluation of enrollee satisfaction with individual plan physicians typically involves surveying a sample of each physician's patients who have had a recent visit to that doctor, and then providing a report of each individual physician's scores. The assessments, often referred to as individual physician report cards, are conducted in addition to general enrollee satisfaction studies.
Formal use of physician report cards is similar across all HMO size and geographic categories; however, the practice is more prevalent among group-model HMOs, with 85% collecting the information. That compares with 60% for independent practice associations; 59% for mixed-model HMOs; 51% for staff-model HMOs; and 42% for network HMOs.
Of the 41% of HMOs that currently don't collect physician-level satisfaction data, 60% said they will begin collecting such data during the next 12 months. If those plans come to fruition, more than 80% of HMOs will be collecting physician-level data by early 1996.
Of the HMOs collecting physician data, 60% are using the scores as part of a physician compensation/bonus program. Extrapolated over the entire sample of HMOs, 36% are assessing patient satisfaction with individual physicians and using the findings to help determine physician pay.
The larger the HMO, the more likely the data will be used as part of a compensation/bonus program. Some 70% of HMOs with 50,000 or more enrollees use the information for compensation programs. At HMOs with fewer than 50,000 enrollees, it drops to 50%.
Staff, IPA and mixed-model HMOs are more likely to use the data for physician compensation than group-model or network HMOs. Some 67% of IPA and mixed-model plans and 60% of staff-model HMOs use the data for compensation programs, compared with 47% of group-model plans and 33% of networks.
While all HMOs that collect physician satisfaction information do so for their primary-care doctors, half also collect information on enrollee satisfaction with their specialty physicians.
HMOs with 250,000 or more enrollees are significantly more likely to collect data for both primary-care and specialist physicians. Of the larger HMOs, 59% collect data for both, while just 14% collect primary-care data only.
HMOs that collect satisfaction data only for their primary-care physicians are more likely to use it in physician compensation programs than are those that collect the information for both primary-care and specialty physicians.
Sharing the data.
Only one of the 119 HMOs that collect physician satisfaction data said it doesn't report the information to the individual physicians and/or medical groups. Some 54% report the data to individual physicians and their medical groups, 40% report only to individual physicians, and 5% report to medical groups only.
Group-model HMOs (87%) and those with 250,000 or more enrollees (80%) are significantly more likely to share information with individual physicians and their medical groups. Some 67% of staff-model HMOs, 58% of network HMOs and 48% of IPAs share information with both groups. Some 61% of plans with 100,000 to 250,000 enrollees and 48% of HMOs with fewer than 100,000 enrollees share data with physicians and their medical groups.
Data shared with individual physicians and their medical groups are more likely to be used in physician compensation programs than if data are shared only with individual physicians or only with medical groups, the survey shows.