Explaining managed care: What to tell your patients
Explaining managed care: What to tell your patients
Give patients information they can use
(Editor’s note: In the story below, two physicians emphasize the value of providing written material on the basics of managed care to patients. This can save you and your patients time and confusion. In consultation with these physicians, Physician’s Managed Care Report compiled a collection of key managed care topics for patients to understand. A patient handout discussing these key topics is inserted in this month’s issue. You can photocopy this insert and use it throughout your practice to help educate patients on the basics of managed care.)
True story: A beneficiary of a major insurer visited her oral surgeon on several occasions regarding her intense jaw pains. In her second visit, the physician ordered grinding of her teeth. But the patient paused and queried him about his recommendation, saying a dentist friend had discouraged it because it reduced enamel. "Are you questioning me?" The physician snapped. Then the surgeon wadded up a tissue, threw it at the patient, and said, "You’re no different than a welfare patient."
This is not exactly appropriate bedside (or office) manner. Upon leaving, the patient called the insurer and filed several complaints. It is yet to be seen whether the surgeon will remain in the dental managed care panel. Perhaps the physician was venting frustration regarding his problems with managed care, as well as suggesting that he offers different levels of care to different types of patients.
Don’t respond to managed care by venting on your patients; instead, give them rational, clear-cut information, physician leaders suggest. The more you can give them in writing, the better, says Neil Baum, MD, a urologist in New Orleans, who prides himself on having developed a host of handouts for his patients, including information on managed care and procedure-specific information. He also provides handouts on how to use various prescribed drugs.
The demand upon physicians to explain managed care is becoming so great that the AMA decided to develop guidelines for physicians to use when talking to their patients, according to D. Ted Lewers, MD, a nephrologist in Easton, MD, and an AMA trustee.
"Patients have talked to their doctors about insurance for years, but now it has become much more complex," Lewers says. "My patients come in and talk about it all the time. When they see something new, they want to talk about it.
"Often they want to talk about the pros and cons of managed care. Managed care is confusing to the lay person who doesn’t deal with it on a day-to-day basis." The AMA has developed a list of the top 10 questions or priorities patients need to explore in dealing with managed care. It can also be helpful to provide these resources to patients:
• a glossary of key managed care terms;
• a source for checking physician board certification status (Internet site: www.ama-assn.org).
These are the top two questions managed care patients need to ask, says Lewers:
• Is your doctor participating in the plan you want to sign up for? "It’s a staggering statistic that about half of the employed Americans have changed their plans every two years," Lewers says. Given that trend, patients need to start with the doctor they want, then choose the plan that enrolls that physician.
• What are the benefits you will receive, and how are they authorized? Patients should consider their unique needs. If you are pregnant, you’ll want to know if the plan includes well-baby care, neonatal care, etc. If you have a chronic disease, you’ll want to know criteria for coverage of various long-term care needs.
What about the question of whether managed care is better than fee for service? Lewers and Baum steer clear of that question, and point out that studies conflict on that point. The key, they say, is for the patient to trust his or her physician, and to know his or her responsibilities under the plan.
[Editor’s note: To receive a free glossary of managed care terms, contact Francine Wilson at (404) 262-5416 or via e-mail at [email protected].]
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